Provider Demographics
NPI:1376595298
Name:POTTER, STEVEN ROE (MD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:ROE
Last Name:POTTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:STEVE
Other - Middle Name:ROE
Other - Last Name:POTTER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:3800 RESERVOIR RD NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20007-2113
Mailing Address - Country:US
Mailing Address - Phone:202-444-3700
Mailing Address - Fax:877-680-8192
Practice Address - Street 1:3800 RESERVOIR RD NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20007-2113
Practice Address - Country:US
Practice Address - Phone:202-444-3700
Practice Address - Fax:877-680-8192
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN1421204F00000X
DCMD210002345204F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204F00000XAllopathic & Osteopathic PhysiciansTransplant Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8BC183OtherBLUE CROSS BLUE SHIELD
TX198157301Medicaid
TXP00801330OtherRAILROAD MEDICARE
TXP00801330OtherRAILROAD MEDICARE
CAH34149Medicare UPIN
TX8L3812Medicare PIN