Provider Demographics
NPI:1912008285
Name:POTTER, LIZABETH ANN (MD)
Entity Type:Individual
Prefix:
First Name:LIZABETH
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 1:625 W ELM AVE
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:PA
Mailing Address - Zip Code:17331-5125
Mailing Address - Country:US
Mailing Address - Phone:717-632-4900
Mailing Address - Fax:717-632-4313
Practice Address - Street 1:5351 JAYCEE AVE # C
Practice Address - Street 2:SUITE 1
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17112-2938
Practice Address - Country:US
Practice Address - Phone:717-657-2080
Practice Address - Fax:717-657-2290
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2011-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4206312084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1012207630003Medicaid
PA1012207630003Medicaid
PA100216FDBMedicare ID - Type Unspecified