Healthcare Provider Details

I. General information

NPI: 1376524868
Provider Name (Legal Business Name): CHRISTOPHER S OTTIANO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2005
Last Update Date: 02/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1526 ATWOOD AVE SUITE 200
JOHNSTON RI
02919-3289
US

IV. Provider business mailing address

1526 ATWOOD AVE SUITE 200
JOHNSTON RI
02919-3289
US

V. Phone/Fax

Practice location:
  • Phone: 401-270-5395
  • Fax: 401-270-7635
Mailing address:
  • Phone: 401-270-5395
  • Fax: 401-270-7635

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number10215
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number226505
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: