Provider Demographics
NPI:1376576140
Name:OTTO, ALLISON DAWN (MD)
Entity Type:Individual
Prefix:DR
First Name:ALLISON
Middle Name:DAWN
Last Name:OTTO
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:404 MIDDLETOWN BLVD
Mailing Address - Street 2:SUITE 306 PENNS SQUARE
Mailing Address - City:LANGHORNE
Mailing Address - State:PA
Mailing Address - Zip Code:19047-1897
Mailing Address - Country:US
Mailing Address - Phone:215-269-3330
Mailing Address - Fax:215-269-3355
Practice Address - Street 1:404 MIDDLETOWN BLVD
Practice Address - Street 2:SUITE 306 PENNS SQUARE
Practice Address - City:LANGHORNE
Practice Address - State:PA
Practice Address - Zip Code:19047-1897
Practice Address - Country:US
Practice Address - Phone:215-269-3330
Practice Address - Fax:215-269-3355
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2021-06-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD421737208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1014516710001Medicaid
PA233044033OtherTAX ID
PA1113353OtherUSHC
PAK7691OtherHORIZON
PA0001467413OtherBLUE SHIELD