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General NPI Number Information
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NPI Number | 1750524690
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Entity Type | Individual
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Provider Name | CARLOS ALBERTO POTTINGER M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/08/2009
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Last Update Date | 08/26/2024
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Provider Practice Location Address
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Address Line | 2206 WILBORN AVE BLDG 1
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City | SOUTH BOSTON
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State | VA
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Zip | 24592-1630
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Country | US
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Telephone | 434-517-8627
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Fax | 434-517-8080
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Provider Business Mailing Address
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Address Line | 2524 HOUGHTON AVENUE
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City | SOUTH BOSTON
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State | VA
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Zip | 24592
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Country | US
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Telephone | 434-575-1346
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Fax | 203-286-5259
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | ME103639
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 0101262030
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License Number State | VA
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