Provider Demographics
NPI:1912967613
Name:POTTER-KABLOTSKY, CHRISTIAN L (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:L
Last Name:POTTER-KABLOTSKY
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 1:171 MAIN ST STE 203B
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:MA
Mailing Address - Zip Code:01721-1187
Mailing Address - Country:US
Mailing Address - Phone:508-881-3029
Mailing Address - Fax:508-881-1752
Practice Address - Street 1:1 CABOT RD
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:MA
Practice Address - Zip Code:01749-3713
Practice Address - Country:US
Practice Address - Phone:978-562-4160
Practice Address - Fax:978-562-4626
Is Sole Proprietor?:No
Enumeration Date:2006-03-25
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA204760207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110000921AMedicaid
M20128Medicare ID - Type Unspecified
H28941Medicare UPIN