Provider Demographics
NPI:1033491766
Name:H. GREGORY OTA, M.D., P.C
Entity Type:Organization
Organization Name:H. GREGORY OTA, M.D., P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:H
Authorized Official - Middle Name:GREGORY
Authorized Official - Last Name:OTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:781-874-1965
Mailing Address - Street 1:101 MAIN ST
Mailing Address - Street 2:SUITE 216
Mailing Address - City:MEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02155-4540
Mailing Address - Country:US
Mailing Address - Phone:781-874-1965
Mailing Address - Fax:781-874-1967
Practice Address - Street 1:101 MAIN ST
Practice Address - Street 2:SUITE 216
Practice Address - City:MEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02155-4540
Practice Address - Country:US
Practice Address - Phone:781-874-1965
Practice Address - Fax:781-874-1967
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-20
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA54244261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty