Provider Demographics
NPI:1730295817
Name:POTTER, PATRICIA ANN (MD)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:ANN
Last Name:POTTER
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 1:1280 MASSACHUSETTS AVE
Mailing Address - Street 2:SUITE 405
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138-3840
Mailing Address - Country:US
Mailing Address - Phone:617-576-2826
Mailing Address - Fax:
Practice Address - Street 1:1280 MASSACHUSETTS AVE
Practice Address - Street 2:SUITE 405
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-3840
Practice Address - Country:US
Practice Address - Phone:617-576-2826
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA439972084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry