Individual provider Active NPI

Peter Ottaviano, DO

  • Pulmonary Disease Physician
  • Huntington, WV
National Provider Identifier
1114959202
Registry record updated Nov 6, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pulmonary Disease PhysicianTaxonomy code 207RP1001X
License
1144 Issued in WV
Practice address
1249 15TH St
Suite 3000
Huntington, WV 25701-3662
Phone
(304) 691-1000
Fax
(304) 691-1693
NPI assigned
Jul 7, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 6, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pulmonary Disease Physician 207RP1001X 1144 WV Primary

Addresses

Primary practice location

1249 15TH St
Suite 3000
Huntington, WV 25701-3662

Mailing address

1249 15TH St
Suite 3000
Huntington, WV 25701-3662
Phone (304) 691-1000

Other identifiers 4

IdentifierTypeStateIssuer
0042458000MedicaidWV
6407504MedicaidKY
0917128MedicaidOH
290005124OtherRAILROAD MEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy, Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
1144WVMDHearing Instrument Specialist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1152230400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1352160000000",
    "number": "1114959202",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1249 15TH ST",
            "address_2": "SUITE 3000",
            "city": "HUNTINGTON",
            "state": "WV",
            "postal_code": "257013662",
            "telephone_number": "304-691-1000",
            "fax_number": "304-691-1693"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1249 15TH ST",
            "address_2": "SUITE 3000",
            "city": "HUNTINGTON",
            "state": "WV",
            "postal_code": "257013662",
            "telephone_number": "304-691-1000",
            "fax_number": "304-691-1693"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OTTAVIANO",
        "first_name": "PETER",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-07",
        "last_updated": "2012-11-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "WV",
            "license": "1144",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0042458000",
            "state": "WV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6407504",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0917128",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "290005124",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Huntington, WV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.