MEDICARE: BRADLEY POTTS M.D.

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	390200000X	Student in an Organized Health Care Education/Training Program
2	208800000X	Urology Physician	2019-00198	NC

General Provider Information

NPI Number	:	1558716001
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRADLEY POTTS M.D.

Provider Business Mailing Address
First Line	:	8901 WISCONSIN AVE
Second Line	:
City	:	BETHESDA
State	:	MD
Zip	:	20889-0004
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2817 ROCK MERRITT AVENUE
Second Line	:
City	:	FORT LIBERTY
State	:	NC
Zip	:	28310-0004
Country	:	US
Telephone Number	:	910-907-8393
Fax Number	:

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

Provider Enumeration Date	:	05/03/2016
Last Update Date	:	09/25/2023

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