=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619997608
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ROCCO J SANTARELLI D.O.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/20/2006
-----------------------------------------------------
Last Update Date | 02/01/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 311 9TH ST N STE 100
-----------------------------------------------------
City | NAPLES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34102-5886
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-624-8250
-----------------------------------------------------
Fax | 239-624-8251
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 311 9TH ST N STE 100
-----------------------------------------------------
City | NAPLES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34102-5886
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-624-8250
-----------------------------------------------------
Fax | 239-624-8251
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RC0200X
-----------------------------------------------------
Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
-----------------------------------------------------
License Number | OS15753
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207RP1001X
-----------------------------------------------------
Taxonomy Name | Pulmonary Disease Physician
-----------------------------------------------------
License Number | OS006510L
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 207RP1001X
-----------------------------------------------------
Taxonomy Name | Pulmonary Disease Physician
-----------------------------------------------------
License Number | OS15753
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------