Basic Information
| Provider Information | |||||||||
| NPI: | 1184775280 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | OTTENRITTER | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6565 N CHARLES ST | ||||||||
| Address2: | PHYSICIANS PAVILION EAST SUITE 212 | ||||||||
| City: | TOWSON | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212046800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4108231120 | ||||||||
| FaxNumber: | 4102969009 | ||||||||
| Practice Location | |||||||||
| Address1: | 6565 N CHARLES ST | ||||||||
| Address2: | PHYSICIANS PAVILION EAST SUITE 212 | ||||||||
| City: | TOWSON | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212046800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4108231120 | ||||||||
| FaxNumber: | 4102969009 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/15/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | 207V00000X | D31272 | MD | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 252179 | 01 | MD | MAMSI MDIPA OPT CHOICE | OTHER | W3870004 | 01 | MD | BCBS FEDERAL NTL BLUE CHO | OTHER | 4141363 | 01 | MD | AETNA NON HMO | OTHER | 12276 | 01 | MD | AETNA GROUP 122773 | OTHER | KC24 | 01 | MD | BCBS | OTHER |