Provider Demographics
NPI:1215908405
Name:OTTO, BARBARA S (NP)
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:S
Last Name:OTTO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:BARBARA
Other - Middle Name:M
Other - Last Name:SCHEARER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:495 THOMAS JONES WAY
Mailing Address - Street 2:SUITE 210
Mailing Address - City:EXTON
Mailing Address - State:PA
Mailing Address - Zip Code:19341-2553
Mailing Address - Country:US
Mailing Address - Phone:610-560-8550
Mailing Address - Fax:610-280-1569
Practice Address - Street 1:495 THOMAS JONES WAY
Practice Address - Street 2:SUITE 210
Practice Address - City:EXTON
Practice Address - State:PA
Practice Address - Zip Code:19341-2553
Practice Address - Country:US
Practice Address - Phone:610-560-8550
Practice Address - Fax:610-280-1569
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2009-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP007907363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1783498OtherBCBS
PA30027682OtherKEYSTONE MERCY
PA5939631OtherCIGNA
PA10154674801OtherAMERICHOICE
PA1015467480001Medicaid
PA092877VGUMedicare PIN
PA1015467480001Medicaid
PA10154674801OtherAMERICHOICE