Healthcare Provider Details

I. General information

NPI: 1801862826
Provider Name (Legal Business Name): BRIAN M. LOTT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2006
Last Update Date: 02/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 N WALNUT ST
CHILLICOTHEE OH
45601-2420
US

IV. Provider business mailing address

PO BOX 57915
SALT LAKE CITY UT
84157-0915
US

V. Phone/Fax

Practice location:
  • Phone: 740-779-4500
  • Fax:
Mailing address:
  • Phone: 800-328-3054
  • Fax: 801-284-6828

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35062108
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number33892
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: