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General NPI Number Information
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NPI Number | 1689863227
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Entity Type | Organization
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Legal Business Name | JEFFRY POTASH MD PC
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Dates
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Enumeration Date | 10/19/2007
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Last Update Date | 10/19/2007
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Provider Practice Location Address
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Address Line | 63 BELMONT AVENUE SUITE 2
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City | BRATTLEBORO
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State | VT
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Zip | 05301
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Country | US
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Telephone | 802-254-4947
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Fax | 802-257-1454
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Provider Business Mailing Address
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Address Line | 63 BELMONT AVENUE SUITE 2
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City | BRATTLEBORO
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State | VT
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Zip | 05301
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Country | US
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Telephone | 802-254-4947
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Fax | 802-257-1454
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Authorized Official
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Title or Position | PRESIDENT
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Name | JEFFRY BRIAN POTASH
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Credential | MD
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Telephone | 802-254-4947
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 0420009254
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License Number State | VT
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