Provider Demographics
NPI:1942207667
Name:SOTTA, ROBERT PAUL (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:PAUL
Last Name:SOTTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4623 NORWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CHEVY CHASE
Mailing Address - State:MD
Mailing Address - Zip Code:20815-5348
Mailing Address - Country:US
Mailing Address - Phone:503-709-2979
Mailing Address - Fax:
Practice Address - Street 1:17020 SW UPPER BOONES FERRY ROAD
Practice Address - Street 2:SUITE 201
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97224
Practice Address - Country:US
Practice Address - Phone:971-250-0500
Practice Address - Fax:971-250-0501
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-07
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD17330174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
E14198Medicare UPIN
102845Medicare ID - Type Unspecified
ORE14198Medicare UPIN