Individual
MICHEAL POTTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
860 OMNI BLVD, STE 113, NEWPORT NEWS, VA 23606-4434
(757) 327-0657
(757) 240-5096
Mailing address
860 OMNI BLVD, SUITE 303, NEWPORT NEWS, VA 23606-4430
(757) 232-8777
(757) 232-8866
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
0101056088
VA
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
Primary
0101056088
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
080177662
RR/MEDICARE
—
01
—
189518
ANTHEM
VA
01
—
191819
ANTHEM
VA
05
—
5627541
—
VA
Enumeration date
07/28/2005
Last updated
06/20/2017
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