Provider Demographics
NPI:1891721114
Name:BOTTIGLIONE, JOHN ANDREW (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ANDREW
Last Name:BOTTIGLIONE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:11701 LIVINGSTON RD
Mailing Address - Street 2:SUITE 302
Mailing Address - City:FORT WASHINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20744
Mailing Address - Country:US
Mailing Address - Phone:301-292-7400
Mailing Address - Fax:301-292-7062
Practice Address - Street 1:11701 LIVINGSTON RD
Practice Address - Street 2:SUITE 302
Practice Address - City:FORT WASHINGTON
Practice Address - State:MD
Practice Address - Zip Code:20744
Practice Address - Country:US
Practice Address - Phone:301-292-7400
Practice Address - Fax:301-292-7062
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD0000840208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
B93556Medicare UPIN