Healthcare Provider Details

I. General information

NPI: 1013080878
Provider Name (Legal Business Name): ANITA OTT DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 04/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5030 STATE ROAD SUITE 2-400
DREXEL HILL PA
19026-4605
US

IV. Provider business mailing address

5030 STATE ROAD SUITE 2-400
DREXEL HILL PA
19026
US

V. Phone/Fax

Practice location:
  • Phone: 610-394-1365
  • Fax: 610-394-1368
Mailing address:
  • Phone: 610-394-1365
  • Fax: 610-394-1368

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS008470L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: