Provider Demographics
NPI:1972645521
Name:OTIS, ROBERT EUGENE (DPM)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:EUGENE
Last Name:OTIS
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 1:3 LOWER LADD HILL ROAD
Mailing Address - Street 2:
Mailing Address - City:MEREDITH
Mailing Address - State:NH
Mailing Address - Zip Code:03253-5825
Mailing Address - Country:US
Mailing Address - Phone:603-279-5556
Mailing Address - Fax:603-279-3023
Practice Address - Street 1:3 LOWER LADD HILL ROAD
Practice Address - Street 2:
Practice Address - City:MEREDITH
Practice Address - State:NH
Practice Address - Zip Code:03253-5825
Practice Address - Country:US
Practice Address - Phone:603-279-5556
Practice Address - Fax:603-279-3023
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2014-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NHNH175213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
4527338OtherCIGNA
0308269YONH01OtherANTHEM
NH80008269Medicaid
4527338OtherCIGNA
T25739Medicare UPIN