Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204F00000X | Transplant Surgeon | MD432969 | PA |
NPI | 1629006374 |
---|---|
Provider Name | Dr. Shane E Ottmann |
First Address | Harrisburg, PA 17104-1612 |
Second Address | Harrisburg, PA 17104-1619 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2006 |
Last Update Date | 18/12/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
102632009 | (05) | PA |