Individual
RUSSELL R OTTO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.
Contact information
Practice address
201 BOSTON POST RD, WATERFORD, CT 06385
(860) 442-0407
(860) 444-2015
Mailing address
201 BOSTON POST RD, WATERFORD, CT 06385-2805
(860) 442-0407
(604) 442-0158
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
004505
CT
Other
Enumeration date
07/26/2006
Last updated
10/29/2019
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