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General NPI Number Information
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NPI Number | 1700880580
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Entity Type | Individual
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Provider Name | EZRA DOTTINO D.P.M.
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Gender | Male
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Dates
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Enumeration Date | 06/09/2005
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Last Update Date | 09/12/2018
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Provider Practice Location Address
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Address Line | 777 ECHO LAKE RD UNIT F
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City | WATERTOWN
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State | CT
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Zip | 06795
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Country | US
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Telephone | 860-274-1773
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Fax |
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Provider Business Mailing Address
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Address Line | 777 ECHO LAKE RD UNIT F
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City | WATERTOWN
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State | CT
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Zip | 06795-6618
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Country | US
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Telephone | 860-274-1773
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 000686
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License Number State | CT
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