Healthcare Provider Details

I. General information

NPI: 1447245634
Provider Name (Legal Business Name): ROVIE THERESA PATO MESOLA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ROVIE MESOLA M.D.

II. Dates (important events)

Enumeration Date: 09/14/2005
Last Update Date: 08/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 CLARKSON AVE BOX 50
BROOKLYN NY
11203-2012
US

IV. Provider business mailing address

450 CLARKSON AVE BOX 50
BROOKLYN NY
11203-2012
US

V. Phone/Fax

Practice location:
  • Phone: 917-733-4473
  • Fax:
Mailing address:
  • Phone: 917-733-4473
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number244938
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD13057
License Number StateRI
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD60103169
License Number StateWA
# 4
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD21262
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: