Healthcare Provider Details

I. General information

NPI: 1356310635
Provider Name (Legal Business Name): R BRADLEY POTTS NP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/17/2006
Last Update Date: 10/15/2023
Certification Date: 10/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19R MAIN ST
WESTFORD MA
01886-2511
US

IV. Provider business mailing address

19R MAIN ST
WESTFORD MA
01886-2511
US

V. Phone/Fax

Practice location:
  • Phone: 978-692-1937
  • Fax:
Mailing address:
  • Phone: 978-692-1937
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number151841
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number1226
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number151841
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: