Provider Demographics
NPI:1114356284
Name:DAVID TORTORELLA MD LLC
Entity Type:Organization
Organization Name:DAVID TORTORELLA MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:TORTORELLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:781-639-2260
Mailing Address - Street 1:6A BUFFUM STREET EXT
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:MA
Mailing Address - Zip Code:01970-2329
Mailing Address - Country:US
Mailing Address - Phone:781-639-2260
Mailing Address - Fax:
Practice Address - Street 1:238 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:MARBLEHEAD
Practice Address - State:MA
Practice Address - Zip Code:01945-3367
Practice Address - Country:US
Practice Address - Phone:781-639-2260
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-08
Last Update Date:2013-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA246763208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty