Provider Demographics
NPI:1518169630
Name:POTAPOVA, NATALIA (MD)
Entity Type:Individual
Prefix:
First Name:NATALIA
Middle Name:
Last Name:POTAPOVA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 5TH AVE
Mailing Address - Street 2:#1A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-4307
Mailing Address - Country:US
Mailing Address - Phone:917-215-3687
Mailing Address - Fax:917-591-0604
Practice Address - Street 1:25 5TH AVE
Practice Address - Street 2:# 1A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-4307
Practice Address - Country:US
Practice Address - Phone:917-215-3687
Practice Address - Fax:917-591-0604
Is Sole Proprietor?:No
Enumeration Date:2007-06-01
Last Update Date:2013-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY255889207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA07903Medicaid