Provider Demographics
NPI:1811196819
Name:POTASH, MARTIN K (MD)
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:K
Last Name:POTASH
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 1:14275 MIDWAY RD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:ADDISON
Mailing Address - State:TX
Mailing Address - Zip Code:75001-3614
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:610-271-4245
Practice Address - Street 1:695 S BROADWAY STE 100
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80209-4003
Practice Address - Country:US
Practice Address - Phone:303-899-6900
Practice Address - Fax:303-899-6999
Is Sole Proprietor?:No
Enumeration Date:2007-07-11
Last Update Date:2017-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAR8153207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CODR.0051034OtherCO LICENSE
CO07479760Medicaid
COCOA108012Medicare PIN