Healthcare Provider Details

I. General information

NPI: 1811945074
Provider Name (Legal Business Name): LEO C ROTELLO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 08/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8600 OLD GEORGETOWN RD
BETHESDA MD
20814-1422
US

IV. Provider business mailing address

PO BOX 791372
BALTIMORE MD
21279-1372
US

V. Phone/Fax

Practice location:
  • Phone: 301-896-3100
  • Fax: 301-896-2393
Mailing address:
  • Phone: 301-608-8375
  • Fax: 301-608-3979

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberD0052774
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: