Healthcare Provider Details

I. General information

NPI: 1548357361
Provider Name (Legal Business Name): ALISON R. POTTER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 11/08/2022
Certification Date: 11/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1389 GRIZZLY PEAK BLVD
BERKELEY CA
94708-2148
US

IV. Provider business mailing address

1389 GRIZZLY PEAK BLVD
BERKELEY CA
94708-2148
US

V. Phone/Fax

Practice location:
  • Phone: 510-770-6005
  • Fax: 405-335-4704
Mailing address:
  • Phone: 510-770-6005
  • Fax: 405-335-4704

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number51632
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number51632
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberC131666
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: