Provider Demographics
NPI:1497379713
Name:OTT, ERIC ALAN
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:ALAN
Last Name:OTT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 E. BROAD STREET BOX 980509
Mailing Address - Street 2:6TH FLOOR, EW, ROOM 201C
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23298
Mailing Address - Country:US
Mailing Address - Phone:804-727-9319
Mailing Address - Fax:
Practice Address - Street 1:1200 E. BROAD STREET
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23298
Practice Address - Country:US
Practice Address - Phone:804-828-5163
Practice Address - Fax:804-828-7591
Is Sole Proprietor?:No
Enumeration Date:2020-06-02
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101277623207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine