Provider Demographics
NPI:1033385588
Name:POTTA, RUTH SUMANA (MD)
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:SUMANA
Last Name:POTTA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5016 KENT AVE
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55436-2430
Mailing Address - Country:US
Mailing Address - Phone:952-381-7177
Mailing Address - Fax:
Practice Address - Street 1:5016 KENT AVE
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55436-2430
Practice Address - Country:US
Practice Address - Phone:952-381-7177
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-05
Last Update Date:2012-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN51625207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN51625OtherMEDICAL LICENSE