Provider Demographics
NPI:1548357361
Name:POTTER, ALISON R (MD)
Entity type:Individual
Prefix:DR
First Name:ALISON
Middle Name:R
Last Name:POTTER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1389 GRIZZLY PEAK BLVD
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94708-2148
Mailing Address - Country:US
Mailing Address - Phone:510-770-6005
Mailing Address - Fax:405-335-4704
Practice Address - Street 1:1389 GRIZZLY PEAK BLVD
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94708-2148
Practice Address - Country:US
Practice Address - Phone:510-770-6005
Practice Address - Fax:405-335-4704
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA516322084P0800X, 2084P0804X
CAC1316662084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ04665OtherBLUE CROSS/BLUE SHIELD