| Organization Name: | POTOMAC PODIATRY |
| NPI Number: | 1235319948 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | FARIBA AZIZINAMINI (OWNER) |
| Mailing Address: | 11906 Darnestown Rd Suite # G North Potomac |
| State: | MD US |
| Postal Code: | 208782200 |
| Phone Number: | 3012162269 |
| Fax Number: | 3012160288 |
| NPI Enumeration Date: | 11/09/2007 |
| NPI Last Update Date: | 12/28/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 213ES0103X |
| License Number: | 01315 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MD |
| Taxonomy Type: | Podiatric Medicine & Surgery Service Providers |
| Taxonomy Classification: | Podiatrist |
| Taxonomy Specialization: | Foot & Ankle Surgery |
| Taxonomy Definition: | |