Individual
ANDREW T OTTO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
200 PATEWOOD DR STE C100, GREENVILLE, SC 29615-6322
(864) 454-7422
Mailing address
1 INDEPENDENCE PT, SUITE 212, GREENVILLE, SC 29615-4545
(864) 797-6328
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
843
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0313PA
—
SC
Enumeration date
08/10/2006
Last updated
04/20/2017
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