Provider Demographics
NPI:1063592483
Name:POTOCKI, LORRAINE (MD)
Entity type:Individual
Prefix:DR
First Name:LORRAINE
Middle Name:
Last Name:POTOCKI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6701 FANNIN ST
Mailing Address - Street 2:SUITE CC 1560
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2316
Mailing Address - Country:US
Mailing Address - Phone:832-822-4280
Mailing Address - Fax:832-825-4294
Practice Address - Street 1:6701 FANNIN ST
Practice Address - Street 2:SUITE CC 1560
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2316
Practice Address - Country:US
Practice Address - Phone:832-822-4280
Practice Address - Fax:832-825-4294
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK1623208000000X, 207SG0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207SG0201XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Genetics (M.D.)
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX133133207Medicaid
TX116978102Medicaid
TX133133207Medicaid
TXTXB116549Medicare PIN
TX80Y178Medicare PIN
TX116978102Medicaid