=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497816086
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FRANK J BOTTIGLIERI MD FACOO PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/13/2006
-----------------------------------------------------
Last Update Date | 07/16/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6569 NORTH CHARLES STREET SUITE 504
-----------------------------------------------------
City | TOWSON
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21204
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-339-7640
-----------------------------------------------------
Fax | 410-296-1803
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6569 NORTH CHARLES STREET SUITE 504
-----------------------------------------------------
City | TOWSON
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21204
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-339-7640
-----------------------------------------------------
Fax | 410-296-1803
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT OF CORPORATION
-----------------------------------------------------
Name | DR. FRANK J BOTTIGLIERI
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 410-339-7640
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207V00000X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Physician
-----------------------------------------------------
License Number | D26338
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------
=====================================================
Legacy Identifiers
=====================================================
Identifier #1
-----------------------------------------------------
Identifier Code | 1662
-----------------------------------------------------
Identifier Type | OTHER
-----------------------------------------------------
Identifier State | MD
-----------------------------------------------------
Identifier Issuer | P10
-----------------------------------------------------
=====================================================
Proprietary Identifiers Ever Reported
=====================================================
Identifier #1
-----------------------------------------------------
Identifier Code | 1662
-----------------------------------------------------
Identifier Type | OTHER
-----------------------------------------------------
Identifier State | MD
-----------------------------------------------------
Identifier Issuer | P10
-----------------------------------------------------