1942207667 NPI number — ROBERT PAUL SOTTA MD

Table of content: ROBERT PAUL SOTTA MD (NPI 1942207667)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942207667 NPI number — ROBERT PAUL SOTTA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SOTTA
Provider First Name:
ROBERT
Provider Middle Name:
PAUL
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1942207667
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/28/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4623 NORWOOD DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHEVY CHASE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20815-5348
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-709-2979
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
17020 SW UPPER BOONES FERRY ROAD
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
TIGARD
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97224
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
971-250-0500
Provider Business Practice Location Address Fax Number:
971-250-0501
Provider Enumeration Date:
07/07/2005

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: 174400000X , with the licence number:  MD17330 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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