Provider Demographics
NPI:1376670117
Name:ROTELLI, ANTHONY JOSEPH JR (MD)
Entity Type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:JOSEPH
Last Name:ROTELLI
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1524 ATWOOD AVE
Mailing Address - Street 2:SUITE 115
Mailing Address - City:JOHNSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02919
Mailing Address - Country:US
Mailing Address - Phone:401-272-3409
Mailing Address - Fax:401-831-1070
Practice Address - Street 1:1524 ATWOOD AVE
Practice Address - Street 2:SUITE 115
Practice Address - City:JOHNSTON
Practice Address - State:RI
Practice Address - Zip Code:02919
Practice Address - Country:US
Practice Address - Phone:401-272-3409
Practice Address - Fax:401-831-1070
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
RI4945208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
11266OtherRI BLUE CROSS
1900113OtherUHC
RI9001126Medicaid
1900113OtherUHC