Provider Demographics
NPI:1417126087
Name:TORTORELLO, MICHAEL E I (PA-C)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:E
Last Name:TORTORELLO
Suffix:I
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:263 FARMINGTON AVE
Mailing Address - Street 2:PROVIDER ENROLLMENT
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06030-2212
Mailing Address - Country:US
Mailing Address - Phone:860-679-7503
Mailing Address - Fax:860-679-1610
Practice Address - Street 1:21 SOUTH RD
Practice Address - Street 2:DERMATOLOGY
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06032-2410
Practice Address - Country:US
Practice Address - Phone:860-679-4600
Practice Address - Fax:860-679-1248
Is Sole Proprietor?:No
Enumeration Date:2008-02-27
Last Update Date:2012-06-15
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Provider Licenses
StateLicense IDTaxonomies
CT000653363AM0700X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTD400006530Medicare PIN