Healthcare Provider Details

I. General information

NPI: 1659344661
Provider Name (Legal Business Name): PAUL S POTTER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2006
Last Update Date: 03/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 W. MAIN STREET
BELLEVUE OH
44811-9429
US

IV. Provider business mailing address

PO BOX 947
CHAMBERSBURG PA
17201-0947
US

V. Phone/Fax

Practice location:
  • Phone: 419-483-4040
  • Fax: 419-483-1304
Mailing address:
  • Phone: 717-263-5562
  • Fax: 717-263-1566

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number35.073812
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: