Individual
MARK RISEN OTSTOT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1906 BELLEVIEW AVE SE, ROANOKE, VA 24014-1838
(540) 981-7000
Mailing address
213 S JEFFERSON ST STE 1006, ROANOKE, VA 24011-1713
(540) 224-5516
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0110011626
VA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
11/13/2025
Last updated
03/25/2026
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