Provider Demographics
NPI:1861437857
Name:POTTEIGER, JAMES D (PA-C)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:D
Last Name:POTTEIGER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 AUBURN ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04103-6003
Mailing Address - Country:US
Mailing Address - Phone:207-797-4445
Mailing Address - Fax:
Practice Address - Street 1:117 AUBURN ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04103-6003
Practice Address - Country:US
Practice Address - Phone:207-797-4445
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPA-617363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MES93846Medicare UPIN
MEAP1143Medicare ID - Type Unspecified