Basic Information
| Provider Information | |||||||||
| NPI: | 1992801286 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HOTTENTOT | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 349 SNOW POND ROAD | ||||||||
| Address2: | |||||||||
| City: | OAKLAND | ||||||||
| State: | MA | ||||||||
| PostalCode: | 04963 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2074653683 | ||||||||
| FaxNumber: | 2074653429 | ||||||||
| Practice Location | |||||||||
| Address1: | 489 STATE STREET | ||||||||
| Address2: | |||||||||
| City: | BANGOR | ||||||||
| State: | MA | ||||||||
| PostalCode: | 04401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2079737000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/15/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | 207X00000X | 1027 | ME | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
No ID Information.