| Doctor Name: | MR. BRYAN KEITH ODITT |
| NPI Number: | 1023096237 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | APA-C |
| License Number: | 001247 |
| Business Practice Address: | 15 Mohegan Ave New London, CT - 063208100 |
| Business Phone Number: | 8604448207 |
| Business Fax Number: | 8604448413 |
| Mailing Address: | 15 Mohegan Ave, NEW LONDON |
| State: | CT |
| Postal Code: | 063208100 |
| Phone Number: | 8604448207 |
| Fax Number: | 8604448413 |
| NPI Enumeration Date: | 01/06/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | 001247 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CT |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |