Provider Demographics
NPI:1083628382
Name:OTTENSTEIN, KAREN (MD)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:OTTENSTEIN
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 1:793 MAIN RD
Mailing Address - Street 2:
Mailing Address - City:WESTPORT
Mailing Address - State:MA
Mailing Address - Zip Code:02790-4358
Mailing Address - Country:US
Mailing Address - Phone:508-636-7890
Mailing Address - Fax:508-636-7299
Practice Address - Street 1:793 MAIN RD
Practice Address - Street 2:
Practice Address - City:WESTPORT
Practice Address - State:MA
Practice Address - Zip Code:02790
Practice Address - Country:US
Practice Address - Phone:508-636-7890
Practice Address - Fax:508-636-7299
Is Sole Proprietor?:No
Enumeration Date:2006-07-29
Last Update Date:2018-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME021409207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME218430099Medicaid
MEMM269702Medicare PIN
MEE19427Medicare UPIN