Provider Demographics
NPI:1801048293
Name:POTTI, ASHA G (MD)
Entity type:Individual
Prefix:DR
First Name:ASHA
Middle Name:G
Last Name:POTTI
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 1:1406 CRAIN HWY S
Mailing Address - Street 2:SUITE 108
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-4058
Mailing Address - Country:US
Mailing Address - Phone:410-760-0098
Mailing Address - Fax:410-761-9131
Practice Address - Street 1:1406 CRAIN HWY S
Practice Address - Street 2:SUITE 108
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-4058
Practice Address - Country:US
Practice Address - Phone:410-760-0098
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-16
Last Update Date:2011-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD037660207R00000X
MDD0070248207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine