Provider Demographics
NPI:1679648307
Name:OTT, ROSALINDA J (MD)
Entity Type:Individual
Prefix:DR
First Name:ROSALINDA
Middle Name:J
Last Name:OTT
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 1:105 COMMERCIAL ST
Mailing Address - Street 2:
Mailing Address - City:MALDEN
Mailing Address - State:MA
Mailing Address - Zip Code:02148
Mailing Address - Country:US
Mailing Address - Phone:781-322-5101
Mailing Address - Fax:781-322-5820
Practice Address - Street 1:105 COMMERCIAL ST
Practice Address - Street 2:
Practice Address - City:MALDEN
Practice Address - State:MA
Practice Address - Zip Code:02148
Practice Address - Country:US
Practice Address - Phone:781-322-5101
Practice Address - Fax:781-322-5820
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2008-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA36576208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3020983Medicaid
MA3020983Medicaid
043485228OtherTIN
9785973Medicare ID - Type Unspecified