Provider Demographics
NPI:1508431602
Name:OTTONI, LEANNE (MD)
Entity Type:Individual
Prefix:MS
First Name:LEANNE
Middle Name:
Last Name:OTTONI
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 1:1010 MAIN ST FL 2
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14202-1102
Mailing Address - Country:US
Mailing Address - Phone:716-829-5050
Mailing Address - Fax:716-829-5051
Practice Address - Street 1:1010 MAIN ST FL 2
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14202-1102
Practice Address - Country:US
Practice Address - Phone:716-829-5050
Practice Address - Fax:716-829-5051
Is Sole Proprietor?:No
Enumeration Date:2021-05-21
Last Update Date:2023-08-08
Deactivation Date:2022-11-14
Deactivation Code:
Reactivation Date:2023-08-08
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program