Healthcare Provider Details

I. General information

NPI: 1548228224
Provider Name (Legal Business Name): MICHAEL PAUL MORTELLITI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 05/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 NORTH ST PULMONARY MEDICINE
PITTSFIELD MA
01201
US

IV. Provider business mailing address

725 NORTH ST
PITTSFIELD MA
01201-4109
US

V. Phone/Fax

Practice location:
  • Phone: 413-447-2693
  • Fax: 413-447-3111
Mailing address:
  • Phone: 413-447-2752
  • Fax: 413-496-6836

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number10505
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number220775
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number220775
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: