Healthcare Provider Details

I. General information

NPI: 1972671287
Provider Name (Legal Business Name): VINCENT EDWARD MORTELLARO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 N ORANGE AVE STE 240
ORLANDO FL
32804-4641
US

IV. Provider business mailing address

2501 N ORANGE AVE STE 240
ORLANDO FL
32804-4641
US

V. Phone/Fax

Practice location:
  • Phone: 407-303-7280
  • Fax:
Mailing address:
  • Phone: 407-303-7280
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0120X
TaxonomyPediatric Surgery Physician
License Number30918
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberTRN8848
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code2086S0120X
TaxonomyPediatric Surgery Physician
License NumberME179866
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: