MEDICARE: MICHAEL E ROBERTELLO M.D.

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
1	207UN0901X	Nuclear Cardiology Physician	042-0009256	VT
2	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	042-0009256	VT
3	207RC0000X	Cardiovascular Disease Physician	042-0009256	VT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	28918	OTHER	VT	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	1824753	OTHER		CIGNA
4	351070	OTHER		MVP

General Provider Information

NPI Number	:	1447213384
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL E ROBERTELLO M.D.

Provider Business Mailing Address
First Line	:	12 COMMONS ST
Second Line	:
City	:	RUTLAND
State	:	VT
Zip	:	05701-4651
Country	:	US
Telephone Number	:	802-747-3600
Fax Number	:	802-773-8501

Provider Business Practice Location Address
First Line	:	12 COMMONS ST
Second Line	:
City	:	RUTLAND
State	:	VT
Zip	:	05701-4651
Country	:	US
Telephone Number	:	802-747-3600
Fax Number	:	802-773-8501

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/11/2006
Last Update Date	:	11/13/2018

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