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

Table of content: DR. ROBERT OTTENRITTER M.D. (NPI 1184775280)

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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