Provider Demographics
NPI:1659483139
Name:POTASH, PAMELA S (D O)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:S
Last Name:POTASH
Suffix:
Gender:F
Credentials:D O
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1251 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ANNVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17003-1643
Mailing Address - Country:US
Mailing Address - Phone:717-867-4671
Mailing Address - Fax:717-867-4981
Practice Address - Street 1:1251 E MAIN ST
Practice Address - Street 2:
Practice Address - City:ANNVILLE
Practice Address - State:PA
Practice Address - Zip Code:17003-1643
Practice Address - Country:US
Practice Address - Phone:717-867-4671
Practice Address - Fax:717-867-4981
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA0S009893L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
7053141OtherAETNA
7053141OtherUSH/HMO
PA0018076540001Medicaid
P00262035OtherRAILROAD MEDICARE
PA001807654Medicaid
50051245OtherCAPITAL BLUE
P002389OtherGATEWAY
624163OtherBLUE SHIELD
PAH19406Medicare UPIN