Healthcare Provider Details

I. General information

NPI: 1447213384
Provider Name (Legal Business Name): MICHAEL E ROBERTELLO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2006
Last Update Date: 11/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 COMMONS ST
RUTLAND VT
05701-4651
US

IV. Provider business mailing address

12 COMMONS ST
RUTLAND VT
05701-4651
US

V. Phone/Fax

Practice location:
  • Phone: 802-747-3600
  • Fax: 802-773-8501
Mailing address:
  • Phone: 802-747-3600
  • Fax: 802-773-8501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number042-0009256
License Number StateVT
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number042-0009256
License Number StateVT
# 3
Primary TaxonomyN
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License Number042-0009256
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: