Provider Demographics
NPI:1265624647
Name:POTTER, MARISA (MD)
Entity type:Individual
Prefix:
First Name:MARISA
Middle Name:
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 1:20803 BISCAYNE BLVD STE 503
Mailing Address - Street 2:
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33180-1432
Mailing Address - Country:US
Mailing Address - Phone:305-363-1956
Mailing Address - Fax:
Practice Address - Street 1:20803 BISCAYNE BLVD STE 503
Practice Address - Street 2:
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-1432
Practice Address - Country:US
Practice Address - Phone:305-363-1956
Practice Address - Fax:305-630-8578
Is Sole Proprietor?:No
Enumeration Date:2007-08-09
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME117100207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology