Healthcare Provider Details

I. General information

NPI: 1801479894
Provider Name (Legal Business Name): ZACHARY PAUL POTTANAT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2021
Last Update Date: 06/27/2025
Certification Date: 06/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

VCUHS DEPT OF PEDS RESIDENCY, 980264 1250 E. MARSHALL STREET
RICHMOND VA
23298-0264
US

IV. Provider business mailing address

3333 BURNET AVE
CINCINNATI OH
45229-3026
US

V. Phone/Fax

Practice location:
  • Phone: 804-827-0534
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080S0012X
TaxonomyPediatric Sleep Medicine Physician
License Number35.153099
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: