1346240876 NPI number — THOMAS A OTTER MD

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 1346240876 NPI number — THOMAS A OTTER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OTTER
Provider First Name:
THOMAS
Provider Middle Name:
A
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:
1346240876
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/15/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
211 EXECUTIVE DR STE 11
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEWARK
Provider Business Mailing Address State Name:
DE
Provider Business Mailing Address Postal Code:
19702-3358
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
302-451-6913
Provider Business Mailing Address Fax Number:
302-368-7756

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
17005 OLD ORCHARD RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEWES
Provider Business Practice Location Address State Name:
DE
Provider Business Practice Location Address Postal Code:
19958-4828
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
302-644-3311
Provider Business Practice Location Address Fax Number:
302-644-3300
Provider Enumeration Date:
07/27/2005

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: 207X00000X , with the licence number:  C10008890 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 510370286 . This is a "PERDUE FARMS, INC." identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 4056337 . This is a "AETNA US HEALTHCARE" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 510370286 . This is a "ONE NET PPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 264933 . This is a "UNISON HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 510370286 . This is a "DEVON HEALTH SERVICES" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 510370286 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1346240876 , issued by the state of ( DE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3692762000 . This is a "AMERIHEALTH" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 510370286 . This is a "UNION LABOR LIFE INSURANCE COMPANY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1346240876 . This is a "COMMUNITY HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 510370286 . This is a "PRIVATE HEALTHCARE SYSTEMS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 510370286 . This is a "HEALTH NET FEDERAL SERVICES / TRICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1346240876 . This is a "NATIONAL CAPITAL PPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 510370286 . This is a "OPTIMUM CHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 510370286 . This is a "CORVEL CORPORATION" identifier . This identifiers is of the category "OTHER".
  • Identifier: 510370286 . This is a "EASTERN SUSSEX PHYSICIAN ORGANIZATION, P.A. (ESPO)" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1346240876 . This is a "DELAWARE PHYSICIANS CARE, INC." identifier . This identifiers is of the category "OTHER".
  • Identifier: 510370286 . This is a "BLUE CROSS BLUE SHIELD OF DELAWARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1346240876 . This is a "CREENAGHT HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 510370286 . This is a "MULTIPLAN, INC." identifier . This identifiers is of the category "OTHER".




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