Healthcare Provider Details

I. General information

NPI: 1134154248
Provider Name (Legal Business Name): VINCENT JOSEPH ROLLO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 02/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

844 WASHINGTON RD SUITE 102
WESTMINSTER MD
21157-6664
US

IV. Provider business mailing address

PO BOX 900
WESTMINSTER MD
21158-0900
US

V. Phone/Fax

Practice location:
  • Phone: 410-484-8088
  • Fax: 410-871-0083
Mailing address:
  • Phone: 410-871-6502
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License NumberD0052235
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberD0052235
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: