Provider Demographics
NPI:1427002609
Name:OTTINGER, MARLANA (MD)
Entity Type:Individual
Prefix:
First Name:MARLANA
Middle Name:
Last Name:OTTINGER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:291 STONER AVE
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:MD
Mailing Address - Zip Code:21157-5647
Mailing Address - Country:US
Mailing Address - Phone:410-871-6400
Mailing Address - Fax:
Practice Address - Street 1:291 STONER AVE
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157-5647
Practice Address - Country:US
Practice Address - Phone:410-871-6400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2021-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00437542085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDG010 / 0003OtherBLUECHOICE
MD996102000Medicaid
MDKDA7 / 614931-02OtherBC / BS OF MD
MDKDA7 / 614931-02OtherBC / BS OF MD
MDG010 / 0003OtherBLUECHOICE
MD996102000Medicaid