Provider Demographics
NPI:1093021263
Name:POTTER-MCQUILKIN, DINEASHA (MD)
Entity Type:Individual
Prefix:DR
First Name:DINEASHA
Middle Name:
Last Name:POTTER-MCQUILKIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:DINEASHA
Other - Middle Name:
Other - Last Name:POTTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:129 WASHINGTON ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:HOBOKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07030-4657
Mailing Address - Country:US
Mailing Address - Phone:201-795-0501
Mailing Address - Fax:201-963-8231
Practice Address - Street 1:129 WASHINGTON ST
Practice Address - Street 2:SUITE 200
Practice Address - City:HOBOKEN
Practice Address - State:NJ
Practice Address - Zip Code:07030-4657
Practice Address - Country:US
Practice Address - Phone:201-795-0501
Practice Address - Fax:201-963-8231
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-26
Last Update Date:2010-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08694600207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology