Physician Compare National (NPI:1114993367)

HEALTHCARE PROVIDER: SAMUEL J POTOLICCHIO JR. MD

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

Individual Professional Information
NPI	1114993367
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	1557408846
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20091019000423
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	POTOLICCHIO
	Individual professional last name
Provider First Name	SAMUEL
	Individual professional first 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	1974
	Individual professional's medical school graduation year
Primary Specialty	NEUROLOGY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	4910 MASSACHUESETTS AVE NW
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 114
	Group Practice or individual's line 2 address
City	WASHINGTON
	Group Practice or individual's city
State	DC
	Group Practice or individual's state
Zip Code	200164384
	Group Practice or individual's zip code (9 digits when available)
Phone Number	2025374795
	Phone number is listed only when there is a single phone number available for the practice location address

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	090005
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	SIBLEY MEMORIAL HOSPITAL
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y