Provider Demographics
NPI:1114953072
Name:OTTE, GREGORY WARREN (DO)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:WARREN
Last Name:OTTE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 6TH AVE STE 114
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17403-2627
Mailing Address - Country:US
Mailing Address - Phone:717-755-1244
Mailing Address - Fax:717-718-8188
Practice Address - Street 1:1600 6TH AVE
Practice Address - Street 2:SUITE 114
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403-2641
Practice Address - Country:US
Practice Address - Phone:717-755-1244
Practice Address - Fax:717-757-7644
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS004327L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA195352OtherMEDICARE
PA000863200Medicaid
PA000863200Medicaid