MEDICARE: DR. ROBERT ALEXANDER POTH MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	MD067652L	PA
2	208000000X	Pediatrics Physician	2006-01965	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1376536789
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT ALEXANDER POTH MD

Provider Business Mailing Address
First Line	:	624 QUAKER LN
Second Line	:	SUITE 200 D
City	:	HIGH POINT
State	:	NC
Zip	:	27262-3832
Country	:	US
Telephone Number	:	336-878-6101
Fax Number	:	336-878-6155

Provider Business Practice Location Address
First Line	:	624 QUAKER LN
Second Line	:	SUITE 200 D
City	:	HIGH POINT
State	:	NC
Zip	:	27262-3832
Country	:	US
Telephone Number	:	336-878-6101
Fax Number	:	336-878-6155

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/31/2005
Last Update Date	:	07/28/2016

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