Provider Demographics
NPI:1235114737
Name:MOTTO, JOHN M (MD,MPH)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:M
Last Name:MOTTO
Suffix:
Gender:M
Credentials:MD,MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:169 MEDICAL CIR
Mailing Address - Street 2:SUITE A
Mailing Address - City:WEST COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29169-3655
Mailing Address - Country:US
Mailing Address - Phone:803-454-1661
Mailing Address - Fax:803-454-1660
Practice Address - Street 1:169 MEDICAL CIR
Practice Address - Street 2:SUITE A
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29169-3655
Practice Address - Country:US
Practice Address - Phone:803-454-1661
Practice Address - Fax:803-454-1660
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-07
Last Update Date:2012-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC17489208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC651254688OtherBCBS
SC651254688OtherBCBS
SCD16257Medicare UPIN
SCD16257Medicare ID - Type Unspecified