Individual
HAROLD GREGORY OTA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
101 MAIN ST, SUITE 216, MEDFORD, MA 02155-4540
(781) 874-1965
(781) 874-1967
Mailing address
101 MAIN ST, SUITE 216, MEDFORD, MA 02155-4540
(781) 874-1965
(781) 874-1967
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
54244
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3083233
—
MA
01
—
705758
TUFTS HEALTH PLAN
MA
01
—
J05336
BCBS MA
MA
Enumeration date
11/20/2006
Last updated
09/20/2011
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