Provider Demographics
NPI:1538548672
Name:POTOKER, BARRY
Entity type:Individual
Prefix:
First Name:BARRY
Middle Name:
Last Name:POTOKER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10705 JOHN TURLEY PL
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22032-3121
Mailing Address - Country:US
Mailing Address - Phone:703-868-2887
Mailing Address - Fax:
Practice Address - Street 1:10705 JOHN TURLEY PL
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22032-3121
Practice Address - Country:US
Practice Address - Phone:703-868-2887
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-21
Last Update Date:2015-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0126000161174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator