Active NPI
Andre Desouza Potenza, M.D.
- Otolaryngology Physician
- Boston, MA
National Provider Identifier
1962717561
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Otolaryngology Physician
- License
- L-244108
- Practice address
- Massachusetts Eye & Ear Infirmary
243 Charles Street
Boston, MA 02114 - Phone
- (617) 573-3939
- NPI assigned
- Aug 9, 2010
- 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 |
|---|---|---|---|---|
| Otolaryngology Physician | 207Y00000X | L-244108 | MA | Primary |
Addresses
Primary practice location
Massachusetts Eye & Ear Infirmary
243 Charles Street
Boston, MA 02114
Mailing address
Massachusetts Eye & Ear Infirmary
243 Charles Street
Boston, MA 02114
Phone (617) 573-3939
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)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| L-244108 | MA | MD | Otolaryngology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1281312000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1281312000000",
"number": "1962717561",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "MASSACHUSETTS EYE & EAR INFIRMARY",
"address_2": "243 CHARLES STREET",
"city": "BOSTON",
"state": "MA",
"postal_code": "02114",
"telephone_number": "617-573-3939"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "MASSACHUSETTS EYE & EAR INFIRMARY",
"address_2": "243 CHARLES STREET",
"city": "BOSTON",
"state": "MA",
"postal_code": "02114",
"telephone_number": "617-573-3939"
}
],
"practiceLocations": [],
"basic": {
"last_name": "POTENZA",
"first_name": "ANDRE",
"middle_name": "DESOUZA",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2010-08-09",
"last_updated": "2010-08-09",
"status": "A"
},
"taxonomies": [
{
"code": "207Y00000X",
"taxonomy_group": "",
"desc": "Otolaryngology",
"state": "MA",
"license": "L-244108",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Boston, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 9, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.