MEDICARE: DR. JUSTIN PAUL RONDINELLI 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	208000000X	Pediatrics Physician	35.141366	OH
2	2080P0204X	Pediatric Emergency Medicine (Pediatrics) Physician	35.141366	OH
3	390200000X	Student in an Organized Health Care Education/Training Program
4	207R00000X	Internal Medicine Physician	35.141366	OH

General Provider Information

NPI Number	:	1710410477
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JUSTIN PAUL RONDINELLI M.D.

Provider Business Mailing Address
First Line	:	1611 S GREEN RD STE 260
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44121-4192
Country	:	US
Telephone Number	:	216-237-5011
Fax Number	:	216-297-2066

Provider Business Practice Location Address
First Line	:	1611 S GREEN RD STE 260
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44121-4192
Country	:	US
Telephone Number	:	216-237-5011
Fax Number	:	216-297-2066

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

Provider Enumeration Date	:	04/09/2017
Last Update Date	:	09/13/2022

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