# DR. CISSY PAUL POTTANAT

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1295802718
- **Gender:** F
- **Credential:** MD MPH

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 0101052635 | VA | Yes |

## Other

- **Enumeration date:** 11/29/2006
- **Last updated:** 05/29/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 287222 | ANTHEM | — |
| 01 | — | 49D02222254 | CLIA\# | — |
| 05 | — | 5628997 | — | VA |
| 01 | — | F383001 | CALLFIRST | — |