Provider Demographics
NPI:1376524868
Name:OTTIANO, CHRISTOPHER S (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:S
Last Name:OTTIANO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1526 ATWOOD AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:JOHNSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02919-3289
Mailing Address - Country:US
Mailing Address - Phone:401-270-5395
Mailing Address - Fax:401-270-7635
Practice Address - Street 1:1526 ATWOOD AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:JOHNSTON
Practice Address - State:RI
Practice Address - Zip Code:02919-3289
Practice Address - Country:US
Practice Address - Phone:401-270-5395
Practice Address - Fax:401-270-7635
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI10215174400000X
MA226505174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI1700719OtherUHC
RI406994OtherTUFTS
RI7056858Medicaid
RIAA53166OtherHARVARD PILGRIM
27754OtherBCBSRI - BLUE SHIELD
RI27668OtherNHP
RICIGNAOtherPR6379283
RI407203OtherBCBSRI - BLUE CHIP
RI7870190OtherAETNA
RI7056858Medicare PIN
RI406994OtherTUFTS