Provider Demographics
NPI:1023019981
Name:BOTTONE, VICTORIA ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:VICTORIA
Middle Name:ANN
Last Name:BOTTONE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2401 BRANDERMILL BLVD
Mailing Address - Street 2:SUITE 360
Mailing Address - City:GAMBRILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21054-1690
Mailing Address - Country:US
Mailing Address - Phone:410-721-9862
Mailing Address - Fax:410-721-9864
Practice Address - Street 1:2401 BRANDERMILL BLVD
Practice Address - Street 2:SUITE 360
Practice Address - City:GAMBRILLS
Practice Address - State:MD
Practice Address - Zip Code:21054-1690
Practice Address - Country:US
Practice Address - Phone:410-721-9862
Practice Address - Fax:410-721-9864
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2009-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0044081207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD110233170OtherRAILROAD MEDICARE
MD206871100Medicaid
MD2593426OtherAETNA CAPITATED
MD527339-09OtherCAREFIRST MD RENDERING
MD892309OtherMAMSI PRIMARY CARE
MDP14958OtherCAREFIRST MPOS
MD012701OtherJHHC PROVIDER NUMBER
MD5508245OtherAETNA FEE FOR SERVICE
MD292309OtherMAMSI SPECIALIST
MD7109332OtherCIGNA PIN NUMBER
MD7605-0045OtherCAREFIRST BLUECHOICE
MD206871100Medicaid
MD7109332OtherCIGNA PIN NUMBER