Provider Demographics
NPI:1215154562
Name:OTT, STEPHANIE J (MD)
Entity type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:J
Last Name:OTT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:2036 SCHORRWAY DR NW
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-8410
Mailing Address - Country:US
Mailing Address - Phone:740-870-4030
Mailing Address - Fax:740-870-4031
Practice Address - Street 1:2036 SCHORRWAY DR NW
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130-8410
Practice Address - Country:US
Practice Address - Phone:740-870-4030
Practice Address - Fax:740-870-4031
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2022-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-086670207RR0500X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHCD3781OtherMEDICARE RAILROAD
OH002748950Medicaid
OHOT4211211Medicare PIN