MEDICARE: OTTONELLO RHEUMATOLOGY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RR0500X	Rheumatology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1295914067
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OTTONELLO RHEUMATOLOGY LLC

Provider Business Mailing Address
First Line	:	500 NAYSMITH ROAD
Second Line	:
City	:	NORTH VERSAILLES
State	:	PA
Zip	:	15137-2340
Country	:	US
Telephone Number	:	412-673-8110
Fax Number	:	412-673-6223

Provider Business Practice Location Address
First Line	:	500 NAYSMITH ROAD
Second Line	:
City	:	NORTH VERSAILLES
State	:	PA
Zip	:	15137-2340
Country	:	US
Telephone Number	:	412-673-8110
Fax Number	:	412-673-6223

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DOMINGO G OTTONELLO
Credential	:	MD
Telephone Number	:	412-673-8110

Provider Enumeration Date	:	10/30/2007
Last Update Date	:	06/11/2015

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