Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | MD045572E | PA |
Y | 208600000X | Surgeon | MD045572E | PA |
NPI | 1013971209 |
---|---|
Provider Name | Dr. David Avery Bottger |
First Address | Newtown Square, PA 19073-2304 |
Second Address | Newtown Square, PA 19073-2304 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/04/2006 |
Last Update Date | 25/02/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000612038 | PA BLUE SHIELD (01) | PA |
0440161000 | KEYSTONE HEALTHPLAN (01) | PA |
1046353003 | CIGNA (01) | PA |
99581 | AETNA HEALTHCARE (01) | PA |
E65370 | (02) | PA |