Healthcare Provider Details

I. General information

NPI: 1558997205
Provider Name (Legal Business Name): LINDSEY MARIE VOLLER ROTTO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LINDSEY MARIE VOLLER MD

II. Dates (important events)

Enumeration Date: 03/13/2020
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4656 40TH AVE S
FARGO ND
58104-4397
US

IV. Provider business mailing address

3878 3RD ST E
WEST FARGO ND
58078-8213
US

V. Phone/Fax

Practice location:
  • Phone: 701-234-8860
  • Fax:
Mailing address:
  • Phone: 701-851-0580
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License NumberPT24856
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: