Provider Demographics
NPI:1679582639
Name:POTTER, STEVEN DARREN (MD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:DARREN
Last Name:POTTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:287 BLVD.
Mailing Address - Street 2:SUITE #1
Mailing Address - City:POMPTON PLAINS
Mailing Address - State:NJ
Mailing Address - Zip Code:07405
Mailing Address - Country:US
Mailing Address - Phone:973-839-7400
Mailing Address - Fax:973-831-4911
Practice Address - Street 1:287 BOULEVARD
Practice Address - Street 2:SUITE #1
Practice Address - City:POMPTON PLAINS
Practice Address - State:NJ
Practice Address - Zip Code:07444-1726
Practice Address - Country:US
Practice Address - Phone:973-839-7400
Practice Address - Fax:973-831-4911
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA056450208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ870907Medicare ID - Type Unspecified
NJG34060Medicare UPIN