Otar Datiashvili, MD
Emergency Medicine in Bloomington, Indiana
1083096572- Practice location
- 2651 E Discovery Pkwy, Bloomington, IN 47408-9059
- Phone
- 812-353-9515
- Fax
- 812-353-9275
- Last updated
- March 5, 2025
Otar Datiashvili is an Emergency Medicine based in Bloomington, IN. Otar Datiashvili practices in Bloomington, IN and has the professional credentials of MD. The NPI Number for Otar Datiashvili is 1083096572 and holds a License No. 01093706A (IN). The current practice location address for Otar Datiashvili is 2651 E Discovery Pkwy, Bloomington, IN 47408-9059 and can be reached out via phone at 812-353-9515 and via fax at 812-353-9275.
Provider Profile Details
- NPI Number
- 1083096572
- Provider Name
- Otar Datiashvili
- Credential
- MD
- Provider Entity Type
- Individual
- Gender
- Male
- Address
- 2651 E Discovery Pkwy, Bloomington, IN 47408-9059
- Phone Number
- 812-353-9515
- Fax Number
- 812-353-9275
- Primary Taxonomy
- Emergency Medicine · 207P00000X
- Sole Proprietor
- Yes
- Provider Enumeration Date
- June 22, 2015
- Last Update Date
- March 5, 2025
- Certification Date
- March 5, 2025
- NPI Status
- Active
Provider Business Practice Location Address Details
- Address
- 2651 E Discovery Pkwy
Bloomington, IN 47408-9059 - City
- Bloomington
- State
- Indiana
- Zip
- 47408-9059
- Phone Number
- 812-353-9515
- Fax Number
- 812-353-9275
Provider Business Mailing Address Details
- Address
- 250 N Shadeland Ave
Indianapolis, IN 46219-4959 - City
- Indianapolis
- State
- IN
- Zip
- 46219-4959
License Information
- License Number (1)
- 01093706A
- License State (1)
- IN
- Taxonomy (1)
- Emergency Medicine · 207P00000X · Primary
- License Number (2)
- 273598-1
- License State (2)
- NY
- Taxonomy (2)
- Emergency Medicine · 207P00000X
Legacy Identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| No legacy identifiers (Medicaid, Medicare or plan IDs) are on file for this provider. | |||
Other Emergency Medicine providers near Bloomington, IN
View all Emergency Medicine providers in Bloomington →Frequently Asked Questions
What is the NPI number of Otar Datiashvili, MD?
The NPI number of Otar Datiashvili, MD is 1083096572. It was assigned on June 22, 2015 and is currently active in the NPPES registry.
What is the specialty of Otar Datiashvili, MD?
Otar Datiashvili, MD is registered under the primary taxonomy Emergency Medicine (code 207P00000X), licensed in IN under license number 01093706A.
Where does Otar Datiashvili, MD practice?
The practice location is 2651 E Discovery Pkwy, Bloomington, IN 47408-9059. The office can be reached at 812-353-9515 (phone) or 812-353-9275 (fax).
What is an NPI number?
A National Provider Identifier (NPI) is a unique 10-digit identification number issued to health care providers in the United States by the Centers for Medicare and Medicaid Services (CMS). It is used in HIPAA standard transactions.
How do I verify this NPI record?
This record is sourced from the public NPPES NPI Registry maintained by CMS. You can confirm it by searching NPI 1083096572 directly on the NPPES registry website.