Provider Demographics
NPI:1841383338
Name:OTTOLENGHI, DAVID R (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:R
Last Name:OTTOLENGHI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2121 E HARMONY RD
Mailing Address - Street 2:SUITE 310
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80528
Mailing Address - Country:US
Mailing Address - Phone:970-221-3855
Mailing Address - Fax:970-212-1238
Practice Address - Street 1:2121 E HARMONY RD
Practice Address - Street 2:SUITE 310
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80528
Practice Address - Country:US
Practice Address - Phone:970-221-3855
Practice Address - Fax:970-212-1238
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2008-05-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CO33484207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CN8518Medicare PIN
F16660Medicare UPIN