1184775280 NPI number — DR. ROBERT OTTENRITTER M.D.

Table of content: PAUL VINCENT SEJUD DMD (NPI 1881779387)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184775280 NPI number — DR. ROBERT OTTENRITTER M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OTTENRITTER
Provider First Name:
ROBERT
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1184775280
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6565 N CHARLES ST
Provider Second Line Business Mailing Address:
PHYSICIANS PAVILION EAST SUITE 212
Provider Business Mailing Address City Name:
TOWSON
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21204-6800
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-823-1120
Provider Business Mailing Address Fax Number:
410-296-9009

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6565 N CHARLES ST
Provider Second Line Business Practice Location Address:
PHYSICIANS PAVILION EAST SUITE 212
Provider Business Practice Location Address City Name:
TOWSON
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21204-6800
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-823-1120
Provider Business Practice Location Address Fax Number:
410-296-9009
Provider Enumeration Date:
01/15/2007

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: 207V00000X , with the licence number:  D31272 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 252179 . This is a "MAMSI MDIPA OPT CHOICE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: W3870004 . This is a "BCBS FEDERAL NTL BLUE CHO" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 4141363 . This is a "AETNA NON HMO" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 12276 . This is a "AETNA GROUP 122773" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: KC24 . This is a "BCBS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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