Maxine Pottenger, MD

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

A165796 Issued in CA

Practice address

2101 Courage Dr
Fairfield, CA 94533-6717

Phone

(707) 784-4900

Fax

(707) 399-4957

NPI assigned

Feb 10, 2014

Last updated

Jun 29, 2021By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Interoperability endpoints

• Direct secure messaging: mpottenger31052@direct.kennedykrieger.org

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1391990400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1624924800000",
    "number": "1932523081",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2101 COURAGE DR",
            "city": "FAIRFIELD",
            "state": "CA",
            "postal_code": "945336717",
            "telephone_number": "707-784-4900",
            "fax_number": "707-399-4957"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2101 COURAGE DR",
            "city": "FAIRFIELD",
            "state": "CA",
            "postal_code": "945336717",
            "telephone_number": "707-784-4900",
            "fax_number": "707-399-4957"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1800 Orleans St",
            "address_purpose": "LOCATION",
            "city": "Baltimore",
            "state": "MD",
            "postal_code": "212870010",
            "country_code": "US",
            "telephone_number": "410-955-5000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "POTTENGER",
        "first_name": "MAXINE",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-02-10",
        "last_updated": "2021-06-29",
        "certification_date": "2021-06-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "CA",
            "license": "A165796",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Adrianna Portugal
• Lourdes Posadas
• Karan Deborah Post, MFT
• Donald Nathaniel Poston Sr., RAS
• Julie Potrykus
• Dawn Poulsen
• Alexandria Powell
• Jonathan Kitisak Powell, BSN, RN
• Paresh H Pravin, MD
• Adrienne Marie Preisig, PHARM D

• Psychiatry Physician in Fairfield, CA
• Providers in Fairfield, CA by specialty
• Psychiatry Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.