1619985082 NPI number — DR. LAURA ANNE POTVIN, P.C.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619985082 NPI number — DR. LAURA ANNE POTVIN, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DR. LAURA ANNE POTVIN, P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1619985082
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/07/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
291 MAIN ST
Provider Second Line Business Mailing Address:
P.O. BOX 232
Provider Business Mailing Address City Name:
GROVELAND
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01834-1234
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-837-3790
Provider Business Mailing Address Fax Number:
978-373-7852

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
291 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GROVELAND
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01834-1234
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-374-8991
Provider Business Practice Location Address Fax Number:
978-373-7852
Provider Enumeration Date:
08/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
POTVIN
Authorized Official First Name:
LAURA
Authorized Official Middle Name:
ANNE
Authorized Official Title or Position:
OWNER, CEO
Authorized Official Telephone Number:
508-837-3790

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  3365 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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