Provider Demographics
NPI:1427149798
Name:POTLER, ANDREW W (DO)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:W
Last Name:POTLER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:780 MAIN ST
Mailing Address - Street 2:STE 1
Mailing Address - City:GT BARRINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01230-2180
Mailing Address - Country:US
Mailing Address - Phone:413-528-2418
Mailing Address - Fax:413-528-2907
Practice Address - Street 1:780 MAIN ST
Practice Address - Street 2:
Practice Address - City:GT BARRINGTON
Practice Address - State:MA
Practice Address - Zip Code:01230-2180
Practice Address - Country:US
Practice Address - Phone:413-528-2418
Practice Address - Fax:413-528-2907
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2014-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA58640207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3057763Medicaid
110224982OtherPALMETTO GBA - RAILROAD MEDICARE
MA000000020989OtherBMC HEALTHNET
A64549Medicare UPIN
MA3057763Medicaid