Provider Demographics
NPI:1013080878
Name:OTT, ANITA (DO)
Entity Type:Individual
Prefix:DR
First Name:ANITA
Middle Name:
Last Name:OTT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Other - Last Name:
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Mailing Address - Street 1:5030 STATE ROAD
Mailing Address - Street 2:SUITE 2-400
Mailing Address - City:DREXEL HILL
Mailing Address - State:PA
Mailing Address - Zip Code:19026
Mailing Address - Country:US
Mailing Address - Phone:610-394-1365
Mailing Address - Fax:610-394-1368
Practice Address - Street 1:5030 STATE ROAD
Practice Address - Street 2:SUITE 2-400
Practice Address - City:DREXEL HILL
Practice Address - State:PA
Practice Address - Zip Code:19026-4605
Practice Address - Country:US
Practice Address - Phone:610-394-1365
Practice Address - Fax:610-394-1368
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2014-04-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAOS008470L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001856710Medicaid
PAG59505Medicare UPIN
PA001856710Medicaid