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General NPI Number Information
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NPI Number | 1932442951
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Entity Type | Individual
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Provider Name | FADAR OLIVER OTITE M.D, SCM
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Gender | Male
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Dates
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Enumeration Date | 03/27/2013
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Last Update Date | 01/28/2022
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Provider Practice Location Address
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Address Line | 1611 NW 12TH AVE MEDICINE
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City | MIAMI
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State | FL
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Zip | 33136-1005
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Country | US
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Telephone | 857-294-8078
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Fax |
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Provider Business Mailing Address
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Address Line | 750 EAST ADAMS ST NEUROLOGY
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City | SYRACUSE
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State | NY
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Zip | 13210-1834
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Country | US
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Telephone | 857-294-8078
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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 | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | 298744
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2084A2900X
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Taxonomy Name | Neurocritical Care Physician
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License Number | 298744
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License Number State | NY
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