Marivic Dayrit Botta, M.D.
Individual provider Active NPI Pediatrics Physician · Trumbull, CT
NPI 1013055102 · NPPES record last updated Jun 18, 2024
Key facts
- NPI
- 1013055102
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatrics Physician 208000000X
- License
- 045299 (CT)
- Practice address
- 15 Corporate Dr
Trumbull, CT 06611-1351 - Phone
- (203) 452-8322
- NPI assigned
- Feb 2, 2007
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 045299 | CT | MD | Specialist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Optimus Health Care Inc | Past | Accepting new patients | |
| Optimus Health Care Inc | Past | Accepting new patients | |
| Fairfield County Healthcare Associates | Pediatrics | Past | Accepting new patients |
Interoperability endpoints
- marivicd.botta@xdr.hhchealthdirect.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | 045299 | CT | |
| Pediatrics Physician | 208000000X | 045299 | CT | Yes |
Addresses
Primary practice location
15 Corporate Dr
Trumbull, CT 06611-1351
Mailing address
100 Beard Sawmill Rd
Shelton, CT 06484-6150
Phone (203) 452-8322
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 061319954 | Other | CT | TAX ID# |
Other providers in Trumbull, CT
- John J Bogannam
- Poornima Bond
- David Bonheim
- Bryanna Bonner
- Peter Stuart Boone
- Amy Boudreau
- Hanaa Dabaa Boutros
- Laura Bracale
- David M. Brady
- Natalia Brakoniecki
All providers in Trumbull, CT · Pediatrics Physician in Connecticut
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 18, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.