Provider Demographics
NPI:1598839110
Name:POTTASH, CARTER A (MD)
Entity type:Individual
Prefix:DR
First Name:CARTER
Middle Name:A
Last Name:POTTASH
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:PO BOX 381
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33480-0381
Mailing Address - Country:US
Mailing Address - Phone:561-837-2215
Mailing Address - Fax:
Practice Address - Street 1:339 ROYAL POINCIANA PLAZA
Practice Address - Street 2:SUITE G
Practice Address - City:PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33480
Practice Address - Country:US
Practice Address - Phone:561-837-2215
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2014-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0344562084A0401X, 2084P0800X, 2084P0802X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Medicine
No2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Psychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLC62878Medicare UPIN