Provider Demographics
NPI:1033187851
Name:OTTO, PATRICIA M (MD)
Entity type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:M
Last Name:OTTO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:470 BIRCHWOOD AVE STE A
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-1781
Mailing Address - Country:US
Mailing Address - Phone:360-734-1960
Mailing Address - Fax:360-647-8720
Practice Address - Street 1:470 BIRCHWOOD AVE
Practice Address - Street 2:SUITE A
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-1781
Practice Address - Country:US
Practice Address - Phone:360-734-1960
Practice Address - Fax:360-647-8720
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-08
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00016861025209174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1807007Medicaid
WA1807007Medicaid
WA001400163Medicare ID - Type Unspecified