Provider Demographics
NPI:1982678348
Name:POTTER, ROBERT H (MD)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:H
Last Name:POTTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:5700 CORPORATE DR
Mailing Address - Street 2:SUITE 700, BLDG 3
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15237-5861
Mailing Address - Country:US
Mailing Address - Phone:412-630-2670
Mailing Address - Fax:412-630-2695
Practice Address - Street 1:5700 CORPORATE DR
Practice Address - Street 2:SUITE 700, BLDG 3
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15237-5861
Practice Address - Country:US
Practice Address - Phone:412-630-2670
Practice Address - Fax:412-630-2695
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD029646E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0010114750012Medicaid
PA080084056OtherRAILROAD MEDICARE
PA0010114750012Medicaid
PA423197Medicare ID - Type Unspecified