Provider Demographics
NPI:1659380327
Name:ROTOLI, DINA MARIE (NP)
Entity Type:Individual
Prefix:
First Name:DINA
Middle Name:MARIE
Last Name:ROTOLI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1445 PORTLAND AVE
Mailing Address - Street 2:SUITE 108
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14621-3036
Mailing Address - Country:US
Mailing Address - Phone:585-922-5550
Mailing Address - Fax:585-922-5950
Practice Address - Street 1:1445 PORTLAND AVE
Practice Address - Street 2:SUITE 108
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14621-3036
Practice Address - Country:US
Practice Address - Phone:585-922-5550
Practice Address - Fax:585-922-5950
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2008-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF3337792086S0129X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02591335Medicaid
NYRA7322Medicare ID - Type Unspecified
NY02591335Medicaid