MEDICARE: DR. SANTOSH POTDAR 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	208600000X	Surgery Physician	35089317	OH
2	208600000X	Surgery Physician	ME114536	FL
3	204F00000X	Transplant Surgery Physician	35089317	OH

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	:	1790740041
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SANTOSH POTDAR MD

Provider Business Mailing Address
First Line	:	17222 HOSPITAL BLVD STE 116
Second Line	:
City	:	BROOKSVILLE
State	:	FL
Zip	:	34601-8925
Country	:	US
Telephone Number	:	352-877-4749
Fax Number	:	352-283-8697

Provider Business Practice Location Address
First Line	:	17222 HOSPITAL BLVD STE 116
Second Line	:
City	:	BROOKSVILLE
State	:	FL
Zip	:	34601-8925
Country	:	US
Telephone Number	:	352-877-4749
Fax Number	:	352-283-8697

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

Provider Enumeration Date	:	04/19/2006
Last Update Date	:	01/10/2023

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Directions to “ DR. SANTOSH POTDAR MD” Practice Location

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