CANDACE R. POTTER


Address: 3535 Southern Blvd, Kettering, OH 45429
Phone: 9372984331

CANDACE R. POTTER (NPI# 1780003517) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1780003517
Entity Type Individual
Full Name CANDACE R. POTTER
Other Name CANDACE R. SHANKS
Credential M.D.
Practice Address 3535 Southern Blvd
Kettering
OH 45429
Mailing Address 3535 Southern Blvd
Kettering
OH 45429-1221
Practice Telephone 9372984331
Enumeration Date 2014-04-09
Last Update Date 2019-06-18
Gender Code F
Is Sole Proprietor N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 2085R0202X Radiology
Specialization: Diagnostic Radiology
35.135122 OH Allopathic & Osteopathic Physicians

Other Provider Identifier

State Issuer Identifier Type Code
OH 14422415 05

Provider Secondary Practice Location

Address Telephone Number Fax Number
3535 Southern Blvd, Kettering, OH 45429 9372984331
55 Lake Avenue North, Worcester, MA 01655 5083341000

Office Location

Street Address 3535 SOUTHERN BLVD
City KETTERING
State OH
Zip Code 45429

Providers in the same location

NPI Name Taxonomy Address Enumeration
1134124183 David M Brouhard Anesthesiology 3535 Southern Blvd, Kettering, OH 45429-1221 2005-06-16
1245846757 Rachel Henderson Pharmacist 3535 Southern Blvd, Kettering, OH 45429-1221 2020-09-21
1235745043 Nipa Mukesh Patel Pharmacist 3535 Southern Blvd, Kettering, OH 45429-1298 2020-09-17
1104437425 Stephanie Elizabeth Nicholls Hospitalist 3535 Southern Blvd, Kettering, OH 45429-1221 2020-08-11
1346865144 Anesthesia Pearls, LLC Nurse Anesthetist, Certified Registered 3535 Southern Blvd, Kettering, OH 45429-1221 2020-06-08
1568087351 Pearl Lee Nurse Anesthetist, Certified Registered 3535 Southern Blvd, Kettering, OH 45429-1221 2020-06-08
1922631761 Michael Patrick Lorey Physician Assistant 3535 Southern Blvd, Kettering, OH 45429-1221 2020-02-20
1801446315 Madison A Tate Physician Assistant 3535 Southern Blvd, Kettering, OH 45429-1221 2019-09-17
1962058966 Joshua Caleb Courlas Physician Assistant 3535 Southern Blvd, Kettering, OH 45429-1221 2019-08-15
1134775273 Jason Raymond Leigh Physician Assistant 3535 Southern Blvd, Kettering, OH 45429-1221 2019-08-14
Find all providers in the same location

Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1821576414 Lauren Danielle Sivley Nurse Practitioner 3535 Sourthern Boulevard, Kettering, OH 45429 2018-08-06
1114446127 Louai Al-samkari Chiropractor 1441 E. Stroop Rd., Kettering, OH 45429 2017-09-12
1407373756 Benjamin Edward Adkins Specialist/Technologist 4116 Vinita Dr., Kettering, OH 45429 2017-08-28
1972036341 James Kim Student in an Organized Health Care Education/Training Program 3535 Southern Boulevard, Kettering, OH 45429 2017-04-04
1023549847 Adrienne Krysiak Emergency Medicine 3525 Southern Boulevard, Kettering, OH 45429 2017-03-23
1386021889 Cassandra Mckoy Counselor 529 East Stroop Road, Kettering, OH 45429 2015-05-04
1417343088 Candace Benoit Obstetrics & Gynecology 3533 Southern Blvd Ste 4600, Dayton, OH 45429 2015-04-10
1275933574 Lee Schwieterman Nurse Practitioner 3535 Southern Blvd., 1 East, Kettering, OH 45429 2014-08-25
1497161947 Robert Jonathon Fresch Jr. Obstetrics & Gynecology 3533 Southern Blvd Ste 3750, Kettering, OH 45429 2014-07-05
1821349812 Lucas Brewer Counselor 1524 E Stroop Rd Ste 300, Kettering, OH 45429 2012-10-01
Find all providers in zip 45429

Taxonomy Information

Taxonomy Code 2085R0202X
Grouping Allopathic & Osteopathic Physicians
Classification Radiology
Specialization Diagnostic Radiology

Taxonomy Definition

A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease.
Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source]
- Additional Resources: American Board of Radiology, 2007. http://www.theabr.org/. American Osteopathic Board of Radiology, 2007. http://www.osteopathic.org/certification
- Board certification for Medical Doctors (MDs) is provided by the American Board of Radiology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Radiology.

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1134147358 Jeffery L Nielson Radiology 1563 E Dorothy Ln, Kettering, OH 45429-3897 2006-07-17
1487641585 First Dayton Radiation Oncology Inc Radiology 2632 Woodman Center Ct, Kettering, OH 45420-1477 2005-10-04
1730699109 Samantha Kilia Trout Radiology 3535 Southern Blvd, Kettering, OH 45429-1221 2017-10-11
1407243926 Katherine Elizabeth Abraham Radiology 3535 Southern Blvd, Kettering, OH 45429-1298 2015-04-22
1770849556 Courtney Joel Frey Radiology 3535 Southern Blvd, Kettering, OH 45429-1221 2012-04-06
1891086286 Nicholas David Romano Radiology 3535 Southern Blvd, Kettering, OH 45429-1221 2011-04-20
1427378256 Mary Elizabeth Mccrate Radiology 3535 Southern Blvd, Kettering, OH 45429-1221 2010-06-03
1740411321 Brian F. Imbrogno Radiology 3535 Southern Blvd, Kettering, OH 45429-1221 2009-07-31
1861588485 Richard M Klein Radiology 3535 Southern Blvd, Kettering, OH 45429-1228 2006-10-04
1417976192 Robert Matthew Lemming Radiology 540 Lincoln Park Blvd, Suite 100, Kettering, OH 45429-6401 2006-07-19
Find all providers in KETTERING

Competitor

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City KETTERING
Zip Code 45429

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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