Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | MD05819 | RI |
N | 111NI0900X | Internist | MD05819 | RI |
N | 207RG0300X | Geriatric Medicine | MD05819 | RI |
Y | 2084N0400X | Neurologist | MD05819 | RI |
NPI | 1124054101 |
---|---|
Provider Name | Brian R Ott |
First Address | Providence, RI 02903-4141 |
Second Address | Providence, RI 02903-4923 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2006 |
Last Update Date | 03/03/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
9006551 | (05) | RI |
A57661 | (02) | RI |