1477607778 NPI number — SUSAN E OTERO MD PC

Table of content: (NPI 1477607778)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477607778 NPI number — SUSAN E OTERO MD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SUSAN E OTERO MD PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1477607778
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/11/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 33548
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WASHINGTON
Provider Business Mailing Address State Name:
DC
Provider Business Mailing Address Postal Code:
20033-0548
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
202-785-4298
Provider Business Mailing Address Fax Number:
202-785-1370

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1145 19TH ST NW
Provider Second Line Business Practice Location Address:
SUITE 717
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
DC
Provider Business Practice Location Address Postal Code:
20036-3701
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
202-785-4298
Provider Business Practice Location Address Fax Number:
202-785-1370
Provider Enumeration Date:
01/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
OTERO
Authorized Official First Name:
J. PABLO
Authorized Official Middle Name:
Authorized Official Title or Position:
PRACTICE ADMINISTRATOR
Authorized Official Telephone Number:
202-785-4298

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  MD14270 , registered in the state of DC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: DA3132 . This is a "MEDICARE RR" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com