Physician Compare National (NPI:1114974227)

HEALTHCARE PROVIDER:

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1114974227
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	4385763531
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20101111000683
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	FORTUNA
	Individual professional last name
Provider First Name	AMEDEO
	Individual professional first name
Provider Middle Name	L
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	OTHER
	Individual professional's medical school
Graduation Year	1971
	Individual professional's medical school graduation year
Primary Specialty	PODIATRY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	1022 W BROWNING RD
	Group Practice or individual's line 1 address
City	BELLMAWR
	Group Practice or individual's city
State	NJ
	Group Practice or individual's state
Zip Code	080311665
	Group Practice or individual's zip code (9 digits when available)
Phone Number	8569333342
	Phone number is listed only when there is a single phone number available for the practice location address

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	Y