NPI 1962817619 · live from the CMS NPI Registry
Justin Otis, MD
Psychiatry & Neurology, Behavioral Neurology & Neuropsychiatry in Bangor, ME. National Provider Identifier 1962817619, active.
NPI record
| NPI | 1962817619 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Psychiatry & Neurology, Behavioral Neurology & Neuropsychiatry 2084B0040X |
| Practice location | 268 Stillwater Ave, Bangor, ME 04401 |
| Practice phone | 207-973-6100 |
| Enumerated | June 20, 2014 |
| Last updated | February 24, 2023 |
| Sole proprietor | No |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Psychiatry & Neurology, Behavioral Neurology & Neuropsychiatry | 2084B0040X | MD-48057 (IA) |
| Psychiatry & Neurology, Behavioral Neurology & Neuropsychiatry | 2084B0040X | CDRH.0060526 (CO) |
| Psychiatry & Neurology, Behavioral Neurology & Neuropsychiatry | 2084B0040X | 404-320 (WI) |
| Psychiatry & Neurology, Neurology | 2084N0400X | 404 (WI) |
| Psychiatry & Neurology, Psychiatry | 2084P0800X | 404-320 (WI) |
| Psychiatry & Neurology, Behavioral Neurology & Neuropsychiatry primary | 2084B0040X | MD26700 (ME) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.