Active NPI
Marc N Potenza, MD PHD
- Psychiatry Physician
- Middletown, CT
National Provider Identifier
1598887218
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- 035340
- Practice address
- 2 Vance Drive
Connecticut Valley Hospital Problem Gambling Services R
Middletown, CT 06457 - Phone
- (860) 344-2244
- Fax
- (860) 344-2360
- NPI assigned
- Apr 4, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | 035340 | CT | Primary |
Addresses
Primary practice location
2 Vance Drive
Connecticut Valley Hospital Problem Gambling Services R
Middletown, CT 06457
Mailing address
PO Box 351
2 Vance Drive Connecticut Valley Hospital Problem Gambl
Middletown, CT 06457
Phone (860) 344-2244
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine, Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 035340 | CT | MD | Psychiatry Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| The Connection Inc. | Past | Accepting new patients | |
| State of Connecticut | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
dba Connecticut Mental Health Center
- Psychiatric Hospital
- New Haven, CT
- NPI 1881629434
-
- Adult Mental Health Clinic/Center
- New Haven, CT
- NPI 1992823538
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1175644800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1598887218",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 351",
"address_2": "2 VANCE DRIVE CONNECTICUT VALLEY HOSPITAL PROBLEM GAMBL",
"city": "MIDDLETOWN",
"state": "CT",
"postal_code": "06457",
"telephone_number": "860-344-2244",
"fax_number": "860-344-2360"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2 VANCE DRIVE",
"address_2": "CONNECTICUT VALLEY HOSPITAL PROBLEM GAMBLING SERVICES R",
"city": "MIDDLETOWN",
"state": "CT",
"postal_code": "06457",
"telephone_number": "860-344-2244",
"fax_number": "860-344-2360"
}
],
"practiceLocations": [],
"basic": {
"last_name": "POTENZA",
"first_name": "MARC",
"middle_name": "N",
"name_prefix": "Dr.",
"credential": "MD PHD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-04-04",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "CT",
"license": "035340",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Middletown, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.