Provider Demographics
NPI:1083818363
Name:TIMOTHY T. OTT, D.O. AND ASSOCIATES, P.C.
Entity Type:Organization
Organization Name:TIMOTHY T. OTT, D.O. AND ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRYSTAL
Authorized Official - Middle Name:P
Authorized Official - Last Name:OTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-276-3050
Mailing Address - Street 1:1145 BOWER HILL RD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15243-1342
Mailing Address - Country:US
Mailing Address - Phone:412-276-3050
Mailing Address - Fax:412-276-5393
Practice Address - Street 1:1145 BOWER HILL RD
Practice Address - Street 2:SUITE 204
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15243-1342
Practice Address - Country:US
Practice Address - Phone:412-276-3050
Practice Address - Fax:412-276-5393
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-12
Last Update Date:2008-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PADA5202OtherRR MEDICARE GROUP NUMBER
PA1537261OtherBLUE SHIELD GROUP NUMBER
PA1537261OtherBLUE SHIELD GROUP NUMBER
PA074858Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER