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General NPI Number Information
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NPI Number | 1376670117
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Entity Type | Individual
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Provider Name | ANTHONY JOSEPH ROTELLI JR. MD
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Gender | Male
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Dates
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Enumeration Date | 02/28/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1524 ATWOOD AVE SUITE 115
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City | JOHNSTON
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State | RI
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Zip | 02919
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Country | US
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Telephone | 401-272-3409
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Fax | 401-831-1070
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Provider Business Mailing Address
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Address Line | 1524 ATWOOD AVE SUITE 115
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City | JOHNSTON
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State | RI
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Zip | 02919
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Country | US
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Telephone | 401-272-3409
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Fax | 401-831-1070
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | 4945
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License Number State | RI
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