MEDICARE: EDGER V POTTER JR MD INC

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	207QG0300X	Geriatric Medicine (Family Medicine) Physician	MD9565	DC
2	207RR0500X	Rheumatology Physician	MD9565	DC
3	207R00000X	Internal Medicine Physician	MD9565	DC

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

General Provider Information

NPI Number	:	1376735100
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EDGER V POTTER JR MD INC

Provider Business Mailing Address
First Line	:	12017 FORT WASHINGTON RD
Second Line	:
City	:	FORT WASHINGTON
State	:	MD
Zip	:	20744-6004
Country	:	US
Telephone Number	:	301-203-9570
Fax Number	:	301-203-1796

Provider Business Practice Location Address
First Line	:	12017 FORT WASHINGTON RD
Second Line	:
City	:	FORT WASHINGTON
State	:	MD
Zip	:	20744-6004
Country	:	US
Telephone Number	:	301-203-9570
Fax Number	:	301-203-1796

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. EDGER VERDAN POTTER JR.
Credential	:	MD
Telephone Number	:	301-203-9570

Provider Enumeration Date	:	08/15/2007
Last Update Date	:	09/16/2011

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