Provider Demographics
NPI:1851533350
Name:ADRIANA OTTO MD PA
Entity Type:Organization
Organization Name:ADRIANA OTTO MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ADRIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:OTTO
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:321-972-8274
Mailing Address - Street 1:1400 S ORLANDO AVE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-5543
Mailing Address - Country:US
Mailing Address - Phone:321-972-8274
Mailing Address - Fax:321-972-8277
Practice Address - Street 1:1400 S ORLANDO AVE
Practice Address - Street 2:SUITE 205
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-5543
Practice Address - Country:US
Practice Address - Phone:321-972-8274
Practice Address - Fax:321-972-8277
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-30
Last Update Date:2009-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME76007207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty