Provider Demographics
NPI:1346240876
Name:OTTER, THOMAS A (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:A
Last Name:OTTER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:211 EXECUTIVE DR STE 11
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19702-3358
Mailing Address - Country:US
Mailing Address - Phone:302-451-6913
Mailing Address - Fax:302-368-7756
Practice Address - Street 1:17005 OLD ORCHARD RD
Practice Address - Street 2:
Practice Address - City:LEWES
Practice Address - State:DE
Practice Address - Zip Code:19958-4828
Practice Address - Country:US
Practice Address - Phone:302-644-3311
Practice Address - Fax:302-644-3300
Is Sole Proprietor?:No
Enumeration Date:2005-07-27
Last Update Date:2019-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC10008890207X00000X, 207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE510370286OtherPERDUE FARMS, INC.
DE4056337OtherAETNA US HEALTHCARE
510370286OtherONE NET PPO
264933OtherUNISON HEALTH PLAN
DE510370286OtherDEVON HEALTH SERVICES
510370286OtherUNITED HEALTHCARE
DE1346240876Medicaid
DE3692762000OtherAMERIHEALTH
510370286OtherUNION LABOR LIFE INSURANCE COMPANY
1346240876OtherCOMMUNITY HEALTH PLAN
510370286OtherPRIVATE HEALTHCARE SYSTEMS
510370286OtherHEALTH NET FEDERAL SERVICES / TRICARE
1346240876OtherNATIONAL CAPITAL PPO
510370286OtherOPTIMUM CHOICE
510370286OtherCORVEL CORPORATION
510370286OtherEASTERN SUSSEX PHYSICIAN ORGANIZATION, P.A. (ESPO)
1346240876OtherDELAWARE PHYSICIANS CARE, INC.
510370286OtherBLUE CROSS BLUE SHIELD OF DELAWARE
1346240876OtherCREENAGHT HEALTH PLAN
510370286OtherMULTIPLAN, INC.
510370286OtherGREAT WEST HEALTHCARE
510370286OtherMAMSI
510370286OtherM.D. IPA
DE510370286OtherCIGNA
P00712879OtherRAILROAD MEDICARE
1346240876OtherCREENAGHT HEALTH PLAN
1346240876OtherNATIONAL CAPITAL PPO
510370286OtherHEALTH NET FEDERAL SERVICES / TRICARE
510370286OtherOPTIMUM CHOICE
510370286OtherMAMSI