MEDICARE: EDINA EVA VON ROTTENTHALER 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	207R00000X	Internal Medicine Physician	ME103839	FL
2	207RH0002X	Hospice and Palliative Medicine (Internal Medicine) Physician	ME103839	FL
3	207RH0002X	Hospice and Palliative Medicine (Internal Medicine) Physician	MD.33284	AL
4	207R00000X	Internal Medicine Physician	MD.33284	AL

General Provider Information

NPI Number	:	1770632341
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDINA EVA VON ROTTENTHALER M.D.

Provider Business Mailing Address
First Line	:	613 MARTIN ST N STE 300
Second Line	:
City	:	PELL CITY
State	:	AL
Zip	:	35125-1337
Country	:	US
Telephone Number	:	205-338-6655
Fax Number	:	205-338-6658

Provider Business Practice Location Address
First Line	:	2804 DR JOHN HAYNES DR
Second Line	:
City	:	PELL CITY
State	:	AL
Zip	:	35125-1438
Country	:	US
Telephone Number	:	205-338-6655
Fax Number	:	205-338-6658

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

Provider Enumeration Date	:	01/10/2007
Last Update Date	:	02/14/2019

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