Provider Demographics
NPI:1144977372
Name:POTOMAC OB GYN
Entity type:Organization
Organization Name:POTOMAC OB GYN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:BADRA
Authorized Official - Last Name:MASIKY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-654-2275
Mailing Address - Street 1:10110 MOLECULAR DR STE 209
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-7547
Mailing Address - Country:US
Mailing Address - Phone:301-654-2275
Mailing Address - Fax:301-654-2456
Practice Address - Street 1:10110 MOLECULAR DR STE 209
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-7547
Practice Address - Country:US
Practice Address - Phone:301-654-2275
Practice Address - Fax:301-654-2456
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-08
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty