Provider Demographics
NPI:1689295511
Name:POTOMAC MEDICAL AESTHETICS, LLC
Entity type:Organization
Organization Name:POTOMAC MEDICAL AESTHETICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:PETROPOULOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-417-8372
Mailing Address - Street 1:7811 MONTROSE RD STE 310
Mailing Address - Street 2:
Mailing Address - City:POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20854-3330
Mailing Address - Country:US
Mailing Address - Phone:301-417-8372
Mailing Address - Fax:
Practice Address - Street 1:7811 MONTROSE RD STE 310
Practice Address - Street 2:
Practice Address - City:POTOMAC
Practice Address - State:MD
Practice Address - Zip Code:20854-3330
Practice Address - Country:US
Practice Address - Phone:301-417-8372
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-01
Last Update Date:2020-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty