Basic Information
| Provider Information | |||||||||
| NPI: | 1659483139 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | POTASH | ||||||||
| FirstName: | PAMELA | ||||||||
| MiddleName: | S | ||||||||
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| Credential: | D. O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1251 E MAIN ST | ||||||||
| Address2: | |||||||||
| City: | ANNVILLE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 170031643 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7178674671 | ||||||||
| FaxNumber: | 7178674981 | ||||||||
| Practice Location | |||||||||
| Address1: | 1251 E MAIN ST | ||||||||
| Address2: | |||||||||
| City: | ANNVILLE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 170031643 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7178674671 | ||||||||
| FaxNumber: | 7178674981 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2006 | ||||||||
| LastUpdateDate: | 03/16/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 03/16/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 0S009893L | PA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 7053141 | 01 | AETNA | OTHER | 7053141 | 01 | USH/HMO | OTHER | 0018076540001 | 05 | PA | MEDICAID | P00262035 | 01 | RAILROAD MEDICARE | OTHER | 001807654 | 05 | PA | MEDICAID | 50051245 | 01 | CAPITAL BLUE | OTHER | P002389 | 01 | GATEWAY | OTHER | 624163 | 01 | BLUE SHIELD | OTHER |