Healthcare Provider Details

I. General information

NPI: 1710185681
Provider Name (Legal Business Name): ETTORE ANDREW MORTARELLI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 BEDFORD ST
WEST BRIDGEWATER MA
02379-1705
US

IV. Provider business mailing address

117 BEDFORD ST
WEST BRIDGEWATER MA
02379-1705
US

V. Phone/Fax

Practice location:
  • Phone: 508-584-9950
  • Fax:
Mailing address:
  • Phone: 508-584-9950
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number5289
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: