Provider Demographics
NPI:1003870189
Name:BOTTI, JOHN J (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:J
Last Name:BOTTI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8508 HAMMOCK DUNES DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28411-7683
Mailing Address - Country:US
Mailing Address - Phone:717-991-2510
Mailing Address - Fax:
Practice Address - Street 1:2212 DELANEY AVE
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-6011
Practice Address - Country:US
Practice Address - Phone:910-332-3660
Practice Address - Fax:910-332-3668
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2017-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNC2011-01476207VM0101X
IN01073484A207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1003870189OtherBCBS
NC1003870189OtherTRICARE
NC1003870189Medicaid
NC1003870189OtherBCBS
C29058Medicare UPIN