Healthcare Provider Details

I. General information

NPI: 1073602884
Provider Name (Legal Business Name): MARY C. OTTOLINI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 05/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 BRAMHALL ST
PORTLAND ME
04102-3134
US

IV. Provider business mailing address

111 MICHIGAN AVE NW
WASHINGTON DC
20010-2978
US

V. Phone/Fax

Practice location:
  • Phone: 207-662-6711
  • Fax: 207-662-6063
Mailing address:
  • Phone: 202-884-2182
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberMD22944
License Number StateME
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD19738
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: