Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | 01073484A | IN |
Y | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | NC2011-01476 | NC |
NPI | 1003870189 |
---|---|
Provider Name | John J Botti |
First Address | Wilmington, NC 28411-7683 |
Second Address | Wilmington, NC 28403-6011 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/04/2006 |
Last Update Date | 03/08/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1003870189 | (05) | NC |
1003870189 | BCBS (01) | NC |
1003870189 | TRICARE (01) | NC |
C29058 | (02) |