Healthcare Provider Details

I. General information

NPI: 1528587243
Provider Name (Legal Business Name): CHRISTOPHER RAYMOND ROTONDO PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2017
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3872 OLD WINTER GARDEN RD SUITE 300
GOTHA FL
34734
US

IV. Provider business mailing address

3872 OLD WINTER GARDEN RD SUITE 300
GOTHA FL
34734
US

V. Phone/Fax

Practice location:
  • Phone: 407-578-6610
  • Fax: 407-578-2247
Mailing address:
  • Phone: 407-578-6610
  • Fax: 407-578-2247

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberPA9110619
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: