Provider Demographics
NPI:1265485056
Name:POTTER, JAMES D (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:D
Last Name:POTTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:82 PETERBOROUGH ST
Mailing Address - Street 2:
Mailing Address - City:JAFFREY
Mailing Address - State:NH
Mailing Address - Zip Code:03452-5860
Mailing Address - Country:US
Mailing Address - Phone:603-532-8775
Mailing Address - Fax:603-532-7482
Practice Address - Street 1:82 PETERBOROUGH ST
Practice Address - Street 2:
Practice Address - City:JAFFREY
Practice Address - State:NH
Practice Address - Zip Code:03452-5860
Practice Address - Country:US
Practice Address - Phone:603-532-8775
Practice Address - Fax:603-532-7482
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2015-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH6554207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH80006554Medicaid
NH80006554Medicaid
NH80006554Medicaid