Alexander Vladimirovich Otellin, MD

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

22592 Issued in WV

Practice address

401 Division St Ste 307
South Charleston, WV 25309-1455

Phone

(304) 932-4259

NPI assigned

Apr 6, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. Confirm with the OIG exclusions search.

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1175817600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1379376000000",
    "number": "1740302066",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "401 DIVISION ST STE 307",
            "city": "SOUTH CHARLESTON",
            "state": "WV",
            "postal_code": "253091455",
            "telephone_number": "304-932-4259"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 DIVISION ST STE 307",
            "city": "SOUTH CHARLESTON",
            "state": "WV",
            "postal_code": "253091455",
            "telephone_number": "304-932-4259"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OTELLIN",
        "first_name": "ALEXANDER",
        "middle_name": "VLADIMIROVICH",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-04-06",
        "last_updated": "2013-09-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "WV",
            "license": "22592",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3810009290",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Bethany Osborne
• David Carroll Osborne III, LPN
• Debra Osborne
• Melissa D Osborne, LP
• Osterman Cotes, M.D. PLLC
• Aspen Otten-Schlinger
• Cecily Overton
• Stephanie Overton
• Gabrielle Owens
• Susan Ann Owens

• Psychiatry Physician in South Charleston, WV
• Providers in South Charleston, WV by specialty
• Psychiatry Physician in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; OIG LEIE.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.