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NPI Code Detail

MEDICARE: DR. ANTHONY DOMINICK ROTELLA DO

MEDICARE: DR. ANTHONY DOMINICK ROTELLA DO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician264788NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1134356249
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ANTHONY DOMINICK ROTELLA DO
Provider Business Mailing Address
First Line : 1001 W FAYETTE ST STE 400
Second Line :
City : SYRACUSE
State : NY
Zip : 13204-2866
Country : US
Telephone Number : 315-937-3026
Fax Number : 315-937-3126
Provider Business Practice Location Address
First Line : 308 W SENECA ST
Second Line :
City : MANLIUS
State : NY
Zip : 13104-2318
Country : US
Telephone Number : 315-682-5080
Fax Number : 315-628-2150
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/16/2009
Last Update Date : 06/04/2024

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