1467441451 NPI number — ANTHONY OTTAVIANI D.O.

Table of Contents

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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