Provider Demographics
NPI:1538384862
Name:POTOSKY, DARRYN R (MD)
Entity type:Individual
Prefix:
First Name:DARRYN
Middle Name:R
Last Name:POTOSKY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12510 PROSPERITY DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-1663
Mailing Address - Country:US
Mailing Address - Phone:240-485-5210
Mailing Address - Fax:240-485-5291
Practice Address - Street 1:7350 VAN DUSEN RD
Practice Address - Street 2:SUITE 210
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-5263
Practice Address - Country:US
Practice Address - Phone:301-498-5500
Practice Address - Fax:301-498-7346
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2017-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD64464207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD512012800Medicaid
MD182097Y1PMedicare PIN
MDP01108545Medicare PIN