Provider Demographics
NPI:1588074546
Name:POTTEIGER, SHAWN (DO)
Entity type:Individual
Prefix:
First Name:SHAWN
Middle Name:
Last Name:POTTEIGER
Suffix:
Gender:
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:PO BOX 34990
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-0627
Mailing Address - Country:US
Mailing Address - Phone:610-644-6900
Mailing Address - Fax:833-941-3871
Practice Address - Street 1:266 LANCASTER AVE STE 200
Practice Address - Street 2:
Practice Address - City:MALVERN
Practice Address - State:PA
Practice Address - Zip Code:19355-3256
Practice Address - Country:US
Practice Address - Phone:610-644-6900
Practice Address - Fax:833-941-3871
Is Sole Proprietor?:No
Enumeration Date:2014-04-30
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOT015934207R00000X
PAOS018386207XX0005X, 207RS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RS0010XAllopathic & Osteopathic PhysiciansInternal MedicineSports Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103346764Medicaid