Healthcare Provider Details

I. General information

NPI: 1487605903
Provider Name (Legal Business Name): TAMMY L ROTONDO APNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TAMMY L PETRIE

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 01/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1630 MAIN ST
CHESTER MD
21619-2791
US

IV. Provider business mailing address

PO BOX 12622
BELFAST ME
04915-4017
US

V. Phone/Fax

Practice location:
  • Phone: 410-604-6560
  • Fax: 410-643-5474
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR177344
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: