Individual
PETER OTTAVIANO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
1249 15TH ST, SUITE 3000, HUNTINGTON, WV 25701-3662
(304) 691-1000
(304) 691-1693
Mailing address
1249 15TH ST, SUITE 3000, HUNTINGTON, WV 25701-3662
(304) 691-1000
(304) 691-1693
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
Primary
1144
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0042458000
—
WV
05
—
0917128
—
OH
01
—
290005124
RAILROAD MEDICARE
—
05
—
6407504
—
KY
Enumeration date
07/07/2006
Last updated
11/06/2012
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