MEDICARE: DR. ERIC ALBERT OTTESEN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2083P0901X	Public Health & General Preventive Medicine Physician	MD12873	DC

General Provider Information

NPI Number	:	1720383771
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ERIC ALBERT OTTESEN M.D.

Provider Business Mailing Address
First Line	:	805 15TH ST NW
Second Line	:	SUITE 601
City	:	WASHINGTON
State	:	DC
Zip	:	20005-2207
Country	:	US
Telephone Number	:	202-728-2462
Fax Number	:	202-974-7892

Provider Business Practice Location Address
First Line	:	805 15TH ST NW
Second Line	:	SUITE 601
City	:	WASHINGTON
State	:	DC
Zip	:	20005-2207
Country	:	US
Telephone Number	:	202-728-2462
Fax Number	:	202-974-7892

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/24/2011
Last Update Date	:	01/24/2011

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