Healthcare Provider Details

I. General information

NPI: 1700580081
Provider Name (Legal Business Name): WILLIAM DOUGLAS ROTELLA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2023
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

749 NORTHERN BLVD
SOUTH ABINGTON TOWNSHIP PA
18411-9062
US

IV. Provider business mailing address

749 NORTHERN BLVD
SOUTH ABINGTON TOWNSHIP PA
18411-9062
US

V. Phone/Fax

Practice location:
  • Phone: 570-319-1046
  • Fax:
Mailing address:
  • Phone: 570-319-1046
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD493942
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: