MEDICARE: DR. VITO CHARLES QUATELA MD

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	207YX0905X	Otolaryngology/Facial Plastic Surgery Physician	147025	NY
2	2082S0099X	Plastic Surgery Within the Head and Neck (Plastic Surgery) Physician	147025	NY

General Provider Information

NPI Number	:	1699715151
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VITO CHARLES QUATELA MD

Provider Business Mailing Address
First Line	:	973 EAST AVE
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14607-2216
Country	:	US
Telephone Number	:	585-244-1000
Fax Number	:	585-271-4786

Provider Business Practice Location Address
First Line	:	973 EAST AVE
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14607-2216
Country	:	US
Telephone Number	:	585-244-1000
Fax Number	:	585-271-4786

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

Provider Enumeration Date	:	06/06/2006
Last Update Date	:	02/02/2016

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