MEDICARE: DR. STEVEN DARREN POTTER M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	MA056450	NJ

General Provider Information

NPI Number	:	1679582639
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEVEN DARREN POTTER M.D.

Provider Business Mailing Address
First Line	:	287 BLVD.
Second Line	:	SUITE #1
City	:	POMPTON PLAINS
State	:	NJ
Zip	:	07405
Country	:	US
Telephone Number	:	973-839-7400
Fax Number	:	973-831-4911

Provider Business Practice Location Address
First Line	:	287 BOULEVARD
Second Line	:	SUITE #1
City	:	POMPTON PLAINS
State	:	NJ
Zip	:	07444-1726
Country	:	US
Telephone Number	:	973-839-7400
Fax Number	:	973-831-4911

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/07/2006
Last Update Date	:	07/08/2007

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