Provider Demographics
NPI:1922717495
Name:POTTILLO, TAMARA BOYD
Entity type:Individual
Prefix:MRS
First Name:TAMARA
Middle Name:BOYD
Last Name:POTTILLO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 YORK RD STE 800
Mailing Address - Street 2:
Mailing Address - City:LUTHERVILLE TIMONIUM
Mailing Address - State:MD
Mailing Address - Zip Code:21093-6011
Mailing Address - Country:US
Mailing Address - Phone:410-376-8728
Mailing Address - Fax:410-862-3774
Practice Address - Street 1:1301 YORK RD STE 800
Practice Address - Street 2:
Practice Address - City:LUTHERVILLE TIMONIUM
Practice Address - State:MD
Practice Address - Zip Code:21093-6011
Practice Address - Country:US
Practice Address - Phone:410-376-8728
Practice Address - Fax:410-862-3774
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-23
Last Update Date:2025-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTPAN1705363LP0808X
MDR197825363LP0808X
DEL8-0010590363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health