Provider Demographics
NPI:1124004403
Name:POTTER, MICHAEL W (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:W
Last Name:POTTER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:5 NEPONSET ST FL CENTER12
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01606-2714
Mailing Address - Country:US
Mailing Address - Phone:508-368-3190
Mailing Address - Fax:508-368-3985
Practice Address - Street 1:123 SUMMER ST
Practice Address - Street 2:SUITE 210
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01608-1312
Practice Address - Country:US
Practice Address - Phone:508-368-3190
Practice Address - Fax:508-368-3985
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2024-05-21
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Provider Licenses
StateLicense IDTaxonomies
MA160784208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
2023718OtherCIGNA HEALTH PLAN
3208125OtherMEDICAID WELFARE
7985198OtherAETNA US HEALTHCARE
MA3208125Medicaid
419312OtherTUFTS HEALTH PLAN
784068OtherMVP HEALTH CARE
2230931OtherFIRST HEALTH
784069OtherMVP HEALTH CARE
J22264OtherBLUE CARE ELECT
04 2472266OtherPRIVATE HEALTHCARE SYST.
04 2472266OtherONE HEALTH PLAN
04 2472266OtherTHREE RIVERS
70438OtherCHILDRENS MEDICAL
70438OtherHEALTHY START
J22264OtherBLUE SHIELD HMO BLUE
AA16160OtherHARVARD PILGRIM HEALTH
60679OtherFALLON COMMUNITY HEALTH
A37468OtherMEDICARE B
04 2472266OtherONE HEALTH PLAN
70438OtherHEALTHY START