Individual
MARY A OTT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1701 N SENATE AVE, DEPT OF PEDIATRICS, INDIANAPOLIS, IN 46202-5306
(317) 962-8067
(317) 962-3796
Mailing address
PO BOX 1026, INDIANAPOLIS, IN 46206-1026
(317) 274-1201
(317) 278-9905
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
01058102
IN
2080A0000X
Pediatric Adolescent Medicine Physician
Primary
01058102
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200454610
—
IN
Enumeration date
08/23/2006
Last updated
12/22/2020
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