Healthcare Provider Details

I. General information

NPI: 1518932698
Provider Name (Legal Business Name): DOUGLAS A POTOKA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3705 5TH AVE CHILDREN'S HOSPITAL, 48485
PITTSBURGH PA
15213-2524
US

IV. Provider business mailing address

3705 5TH AVE CHILDREN'S HOSPITAL, 48485
PITTSBURGH PA
15213-2524
US

V. Phone/Fax

Practice location:
  • Phone: 412-692-7280
  • Fax:
Mailing address:
  • Phone: 412-692-7280
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMD074039L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: