Healthcare Provider Details

I. General information

NPI: 1659354967
Provider Name (Legal Business Name): ALAN MCCALL POTTER PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 MEMORIAL AVE CARROLL HOSPITAL CENTER
WESTMINSTER MD
21157-5726
US

IV. Provider business mailing address

200 MEMORIAL AVE CARROLL HOSPITAL CENTER
WESTMINSTER MD
21157-5726
US

V. Phone/Fax

Practice location:
  • Phone: 410-848-3000
  • Fax: 410-871-6325
Mailing address:
  • Phone: 410-848-3000
  • Fax: 410-871-6325

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC0000841
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: