Provider Demographics
NPI:1790740041
Name:POTDAR, SANTOSH (MD)
Entity Type:Individual
Prefix:DR
First Name:SANTOSH
Middle Name:
Last Name:POTDAR
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 1:17222 HOSPITAL BLVD STE 116
Mailing Address - Street 2:
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34601-8925
Mailing Address - Country:US
Mailing Address - Phone:352-877-4749
Mailing Address - Fax:352-283-8697
Practice Address - Street 1:17222 HOSPITAL BLVD STE 116
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34601-8925
Practice Address - Country:US
Practice Address - Phone:352-877-4749
Practice Address - Fax:352-283-8697
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35089317208600000X, 204F00000X
FLME114536208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No204F00000XAllopathic & Osteopathic PhysiciansTransplant Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001623400Medicaid
FL009381000Medicaid
OH2265856Medicaid
FLHN671YMedicare PIN
OH2265856Medicaid
FLHN671XMedicare PIN
OHPO4202911Medicare PIN