MEDICARE: DR. MICHAEL J BOTTICELLI M.D.

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	174400000X	Specialist	0101057615	VA
2	174400000X	Specialist	D0087500	MD
3	207VX0000X	Obstetrics Physician	0101057615	VA
4	207VX0000X	Obstetrics Physician	D87500	MD

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	:	1962439273
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL J BOTTICELLI M.D.

Provider Business Mailing Address
First Line	:	2291 EVELYN BYRD AVE
Second Line	:
City	:	HARRISONBURG
State	:	VA
Zip	:	22801-5424
Country	:	US
Telephone Number	:	540-434-3831
Fax Number	:	540-432-0518

Provider Business Practice Location Address
First Line	:	25500 POINT LOOKOUT RD
Second Line	:
City	:	LEONARDTOWN
State	:	MD
Zip	:	20650-2015
Country	:	US
Telephone Number	:	301-475-6001
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/26/2006
Last Update Date	:	10/23/2023

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