Provider Demographics
NPI:1952493769
Name:POTTASH, SAMUEL ARON (DPM)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:ARON
Last Name:POTTASH
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6702 CHOKEBERRY RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21209-1404
Mailing Address - Country:US
Mailing Address - Phone:410-272-1334
Mailing Address - Fax:410-272-8984
Practice Address - Street 1:219 W BEL AIR AVE
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:MD
Practice Address - Zip Code:21001
Practice Address - Country:US
Practice Address - Phone:410-272-1334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2012-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD000685213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD371408001Medicaid
0570700001OtherMEDICARE DME
521640693OtherCHAMPUS
T59865Medicare UPIN
MD371408001Medicaid