Healthcare Provider Details

I. General information

NPI: 1346240876
Provider Name (Legal Business Name): THOMAS A OTTER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2005
Last Update Date: 02/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17005 OLD ORCHARD RD
LEWES DE
19958-4828
US

IV. Provider business mailing address

211 EXECUTIVE DR STE 11
NEWARK DE
19702-3358
US

V. Phone/Fax

Practice location:
  • Phone: 302-644-3311
  • Fax: 302-644-3300
Mailing address:
  • Phone: 302-451-6913
  • Fax: 302-368-7756

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberC10008890
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: