Healthcare Provider Details

I. General information

NPI: 1073649653
Provider Name (Legal Business Name): JEFFREY D POTTER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2007
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 BAY LAWN AVE
WARWICK RI
02888-2952
US

IV. Provider business mailing address

20 INGHAM LN
CONCORD MA
01742-2657
US

V. Phone/Fax

Practice location:
  • Phone: 401-941-6162
  • Fax:
Mailing address:
  • Phone: 401-867-0221
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD11955
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number340905
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number230761
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: