Provider Demographics
NPI:1154349207
Name:OTTEN, CARL E (MD)
Entity type:Individual
Prefix:
First Name:CARL
Middle Name:E
Last Name:OTTEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:272 HOSPITAL RD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:CHILLICOTHE
Mailing Address - State:OH
Mailing Address - Zip Code:45601-9031
Mailing Address - Country:US
Mailing Address - Phone:740-779-8234
Mailing Address - Fax:740-779-7477
Practice Address - Street 1:272 HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:OH
Practice Address - Zip Code:45601-9031
Practice Address - Country:US
Practice Address - Phone:740-779-7250
Practice Address - Fax:740-779-7329
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.0760932083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2139699Medicaid
OHOT7342591Medicare PIN
OHB28420Medicare UPIN