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Individual

DOREEN L POTTER

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA

Contact information

Practice address
1134 STATE ROUTE 29, GREENWICH FAMILY HEALTH CENTER, GREENWICH, NY 12834-6107
(518) 692-9861
(518) 692-7947
Mailing address
PO BOX 304, GLENS FALLS, NY 12801-0304
(518) 692-9861
(518) 692-7947

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
005062
NY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
02347400
NY
01
P00370312
RR MEDICARE
NY
Enumeration date
12/19/2005
Last updated
07/13/2012
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