Dr Diana M Ottulich, MD is a medicare enrolled "Military Health Care Provider" physician in Pearl Harbor, Hawaii. Her current practice location is
822 Clark St, Pearl Harbor, Hawaii. You can reach out to her office (for appointments etc.) via phone at
(757) 836-5929.
Dr Diana M Ottulich is licensed to practice in Virginia (license number 0101280042) and she also participates in the medicare program. She does not accept medicare assignments directly but she may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. Her NPI Number is 1629715552.
Physician's Profile
| Full Name | Dr Diana M Ottulich |
|---|
| Gender | Female |
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| Speciality | Military Health Care Provider |
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| Location | 822 Clark St, Pearl Harbor, Hawaii |
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| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
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NPI Data:
- NPI Number: 1629715552
- Provider Enumeration Date: 05/12/2022
- Last Update Date: 05/28/2024
Medicare PECOS Information:
- PECOS PAC ID: 7012394679
- Enrollment ID: I20220519002387
Medical Identifiers
Medical identifiers for Dr Diana M Ottulich such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1629715552 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 208D00000X | General Practice | 0101280042 (Virginia) | Secondary |
| 390200000X | Student In An Organized Health Care Education/training Program | (* (Not Available)) | Secondary |
| 171000000X | Military Health Care Provider | 0101280042 (Virginia) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Dr Diana M Ottulich is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Dr Diana M Ottulich, MD
822 Clark St,
Pearl Harbor, HI 96860-4652
Ph: () - | Dr Diana M Ottulich, MD
822 Clark St,
Pearl Harbor, HI 96860-4652
Ph: (757) 836-5929 |
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