Basic Information
| Provider Information | |||||||||
| NPI: | 1427371202 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | OTT | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | F | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 799 LEXINGTON AVE | ||||||||
| Address2: | |||||||||
| City: | MANSFIELD | ||||||||
| State: | OH | ||||||||
| PostalCode: | 449071906 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4197565133 | ||||||||
| FaxNumber: | 4197749707 | ||||||||
| Practice Location | |||||||||
| Address1: | 799 LEXINGTON AVE | ||||||||
| Address2: | |||||||||
| City: | MANSFIELD | ||||||||
| State: | OH | ||||||||
| PostalCode: | 449071906 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4197565133 | ||||||||
| FaxNumber: | 4197749707 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/08/2010 | ||||||||
| LastUpdateDate: | 04/24/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | R1568 | KY | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207L00000X | 35097714 | OH | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 0053568 | 05 | OH | MEDICAID |