Provider Demographics
NPI:1013686674
Name:HOTTOR, ROBERT KNIEGI
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:KNIEGI
Last Name:HOTTOR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 NORTH CRAIN HWY
Mailing Address - Street 2:SUITE 8 : 9
Mailing Address - City:GLENBURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061
Mailing Address - Country:US
Mailing Address - Phone:443-517-6552
Mailing Address - Fax:410-946-1752
Practice Address - Street 1:550 NORTH CRAIN HWY
Practice Address - Street 2:SUITE 8 : 9
Practice Address - City:GLENBURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061
Practice Address - Country:US
Practice Address - Phone:443-517-6552
Practice Address - Fax:410-946-1752
Is Sole Proprietor?:No
Enumeration Date:2021-09-08
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLP48580164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDLP48580OtherSTATE LIC