Healthcare Provider Details

I. General information

NPI: 1407014095
Provider Name (Legal Business Name): ALISON L POTTER DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2008
Last Update Date: 08/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

774 CHRISTIANA ROAD SUITE 201
NEWARK DE
19713-4221
US

IV. Provider business mailing address

PO BOX 30170
WILMINGTON DE
19805-7170
US

V. Phone/Fax

Practice location:
  • Phone: 302-731-3017
  • Fax: 814-877-4010
Mailing address:
  • Phone: 814-877-6000
  • Fax: 814-877-4010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberOT012652
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberC2-0010563
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: