Basic Information
| Provider Information | |||||||||
| NPI: | 1467441451 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | OTTAVIANI | ||||||||
| FirstName: | ANTHONY | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 201 14TH ST SW | ||||||||
| Address2: | |||||||||
| City: | LARGO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337703133 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7272044893 | ||||||||
| FaxNumber: | 7275857205 | ||||||||
| Practice Location | |||||||||
| Address1: | 201 14TH ST SW | ||||||||
| Address2: | |||||||||
| City: | LARGO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337703133 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7272044893 | ||||||||
| FaxNumber: | 7275857205 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/21/2005 | ||||||||
| LastUpdateDate: | 03/29/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RP1001X | OS3300 | FL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease |
ID Information
| ID | Type | State | Issuer | Description | 81895 | 01 | FL | BCBS BLUE CARE, ADVANTAGE 65 SELECT, MEDICARE PPO/HMO, GO BLUE | OTHER | 10316 | 01 | FL | FLORIDA WELLCARE (MEDICARE PLAN) | OTHER | 81895 | 01 | FL | OUT OF STATE BLUE CROSS BLUE SHIELD | OTHER | 388453 | 01 | FL | UNITED HEALTHCARE COMMERCIAL AND MEDICARE PLANS | OTHER | 81895 | 01 | FL | BLUE OPTIONS, BLUE CHOICE, FEDERAL, FLORIDA STATE AND TRADITIONAL BCBS | OTHER | 0678454 | 01 | FL | CIGNA PPO/HMO, OPEN ACCESS | OTHER | 059637000 | 05 | FL | MEDICAID | 591273247 | 01 | UHC NY STATE EMPIRE PLAN | OTHER | 738136 | 01 | MAIL HANDLERS BENEFIT PLAN (MHBP) | OTHER |