1467441451 NPI number — ANTHONY OTTAVIANI D.O.

Table of content: ANTHONY OTTAVIANI D.O. (NPI 1467441451)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467441451 NPI number — ANTHONY OTTAVIANI D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OTTAVIANI
Provider First Name:
ANTHONY
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1467441451
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/29/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
201 14TH ST SW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LARGO
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33770-3133
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
727-204-4893
Provider Business Mailing Address Fax Number:
727-585-7205

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
201 14TH ST SW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LARGO
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33770-3133
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
727-204-4893
Provider Business Practice Location Address Fax Number:
727-585-7205
Provider Enumeration Date:
10/21/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RP1001X , with the licence number:  OS3300 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 81895 . This is a "BCBS BLUE CARE, ADVANTAGE 65 SELECT, MEDICARE PPO/HMO, GO BLUE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 10316 . This is a "FLORIDA WELLCARE (MEDICARE PLAN)" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 81895 . This is a "OUT OF STATE BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 388453 . This is a "UNITED HEALTHCARE COMMERCIAL AND MEDICARE PLANS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 81895 . This is a "BLUE OPTIONS, BLUE CHOICE, FEDERAL, FLORIDA STATE AND TRADITIONAL BCBS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 0678454 . This is a "CIGNA PPO/HMO, OPEN ACCESS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 059637000 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 591273247 . This is a "UHC NY STATE EMPIRE PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 738136 . This is a "MAIL HANDLERS BENEFIT PLAN (MHBP)" identifier . This identifiers is of the category "OTHER".




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