Provider Demographics
NPI:1700880580
Name:DOTTINO, EZRA (DPM)
Entity type:Individual
Prefix:DR
First Name:EZRA
Middle Name:
Last Name:DOTTINO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:777 ECHO LAKE RD UNIT F
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06795-6618
Mailing Address - Country:US
Mailing Address - Phone:860-274-1773
Mailing Address - Fax:
Practice Address - Street 1:777 ECHO LAKE RD UNIT F
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:CT
Practice Address - Zip Code:06795
Practice Address - Country:US
Practice Address - Phone:860-274-1773
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2018-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000686213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004178126Medicaid
030000686CT03OtherBLUE CROSS AND SHEILD
7571237OtherCIGNA HEALTH PLANS
5394697OtherAETNA HEALTH PLANS
2V5210OtherHEALTHNET
P00144204OtherRAILROAD MEDICARE
P3348525OtherOXFORD HEALTH PLANS
2V5210OtherHEALTHNET
P3348525OtherOXFORD HEALTH PLANS