Provider Demographics
NPI:1164664173
Name:POTTER, MICHAEL QUINN (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:QUINN
Last Name:POTTER
Suffix:
Gender:M
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:PO BOX 79777
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21279-0777
Mailing Address - Country:US
Mailing Address - Phone:434-654-7794
Mailing Address - Fax:434-654-7752
Practice Address - Street 1:3263 PROFFIT RD
Practice Address - Street 2:SUITE 202
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22911-5639
Practice Address - Country:US
Practice Address - Phone:434-654-5575
Practice Address - Fax:434-654-5574
Is Sole Proprietor?:No
Enumeration Date:2009-04-06
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101257603207XS0106X, 207XS0106X
UT7769975-1205207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAVVH819AMedicare PIN
VAP01636499Medicare PIN