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Individual
KEVIN WAYNE OTT
Active
Individual
KEVIN WAYNE OTT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
251466
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0125497
CIGNA HEALTHCARE
NH
01
—
020350051
FEDERAL TAX ID#
—
01
—
04YP07288NH02
ANTHEM BC/BS
NH
01
—
12402
STATE LICENSE #
NH
05
—
30223020
—
NH
01
—
5830418
AETNA GROUP
NH
01
—
P00141342
RAILROAD MEDICARE
—
Enumeration date
08/15/2005
Last updated
03/07/2023
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