Provider Demographics
NPI:1326017880
Name:POTOCKI, JOSEPH A (DO)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:A
Last Name:POTOCKI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:JOSEPH
Other - Middle Name:A
Other - Last Name:POTOCKI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:531 ROBBINS AVE
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:OH
Mailing Address - Zip Code:44446-2411
Mailing Address - Country:US
Mailing Address - Phone:330-544-3431
Mailing Address - Fax:330-544-3432
Practice Address - Street 1:531 ROBBINS AVE
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:OH
Practice Address - Zip Code:44446-2411
Practice Address - Country:US
Practice Address - Phone:330-544-3431
Practice Address - Fax:330-544-3432
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34 002502207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0327748Medicaid
OHPO 0474794Medicare ID - Type Unspecified
OH0327748Medicaid