Provider Demographics
NPI:1376536789
Name:POTH, ROBERT ALEXANDER (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:ALEXANDER
Last Name:POTH
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 1:624 QUAKER LN
Mailing Address - Street 2:SUITE 200 D
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27262-3832
Mailing Address - Country:US
Mailing Address - Phone:336-878-6101
Mailing Address - Fax:336-878-6155
Practice Address - Street 1:624 QUAKER LN
Practice Address - Street 2:SUITE 200 D
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27262-3832
Practice Address - Country:US
Practice Address - Phone:336-878-6101
Practice Address - Fax:336-878-6155
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2016-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD067652L208000000X
NC2006-01965208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5906078Medicaid
SCNC1154Medicaid
PA0017550100007Medicaid
PA0017550100007Medicaid