Provider Demographics
NPI:1417298860
Name:POTTER, BRIAN J (MDCM)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:J
Last Name:POTTER
Suffix:
Gender:M
Credentials:MDCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 APPLETON ST
Mailing Address - Street 2:APARTMENT 3
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02116-6001
Mailing Address - Country:US
Mailing Address - Phone:617-838-0514
Mailing Address - Fax:866-678-6988
Practice Address - Street 1:185 PILGRIM RD
Practice Address - Street 2:BAKER 4 - DIVISION OF CARDIOVASCULAR MEDICINE
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-5324
Practice Address - Country:US
Practice Address - Phone:617-632-7828
Practice Address - Fax:617-632-7536
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-11
Last Update Date:2013-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program