Provider Demographics
NPI:1558346791
Name:POTTER, DONALD EDWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:EDWARD
Last Name:POTTER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2480 LLEWELLYN AVE
Mailing Address - Street 2:KIMBROUGH AMBULATORY CARE CLINIC
Mailing Address - City:FT MEADE
Mailing Address - State:MD
Mailing Address - Zip Code:20755-5800
Mailing Address - Country:US
Mailing Address - Phone:301-677-8270
Mailing Address - Fax:301-677-8176
Practice Address - Street 1:2480 LLEWELLYN AVE
Practice Address - Street 2:KIMBROUGH AMBULATORY CARE CLINIC
Practice Address - City:FT MEADE
Practice Address - State:MD
Practice Address - Zip Code:20755-5800
Practice Address - Country:US
Practice Address - Phone:301-677-8270
Practice Address - Fax:301-677-8176
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-09
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NJMA50801207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAVAD000Medicare UPIN