Organization Name: | POTOMAC INTEGRATIVE HEALTH PLLC |
NPI Number: | 1639412398 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | DAVID DIDDEN (SOLE MEMBER) |
Mailing Address: | 51 Maddex Square Drive Shepherdstown |
State: | WV US |
Postal Code: | 254434310 |
Phone Number: | 3048762447 |
Fax Number: | |
NPI Enumeration Date: | 04/01/2013 |
NPI Last Update Date: | 04/01/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QP2300X |
License Number: | 21679 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WV |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Primary Care |
Taxonomy Definition: |