Provider Demographics
NPI:1467441451
Name:OTTAVIANI, ANTHONY (DO)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:
Last Name:OTTAVIANI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 14TH ST SW
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33770-3133
Mailing Address - Country:US
Mailing Address - Phone:727-204-4893
Mailing Address - Fax:727-585-7205
Practice Address - Street 1:201 14TH ST SW
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33770-3133
Practice Address - Country:US
Practice Address - Phone:727-204-4893
Practice Address - Fax:727-585-7205
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-21
Last Update Date:2017-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS3300207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL81895OtherBCBS BLUE CARE, ADVANTAGE 65 SELECT, MEDICARE PPO/HMO, GO BLUE
FL10316OtherFLORIDA WELLCARE (MEDICARE PLAN)
FL81895OtherOUT OF STATE BLUE CROSS BLUE SHIELD
FL388453OtherUNITED HEALTHCARE COMMERCIAL AND MEDICARE PLANS
FL81895OtherBLUE OPTIONS, BLUE CHOICE, FEDERAL, FLORIDA STATE AND TRADITIONAL BCBS
FL0678454OtherCIGNA PPO/HMO, OPEN ACCESS
FL059637000Medicaid
591273247OtherUHC NY STATE EMPIRE PLAN
738136OtherMAIL HANDLERS BENEFIT PLAN (MHBP)
FL10316OtherFLORIDA WELLCARE (MEDICARE PLAN)
FL059637000Medicaid