Provider Demographics
NPI:1700031531
Name:WALTER ROETTINGER, M.D., INC.
Entity Type:Organization
Organization Name:WALTER ROETTINGER, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:FRANK
Authorized Official - Last Name:ROETTINGER
Authorized Official - Suffix:II
Authorized Official - Credentials:MD
Authorized Official - Phone:401-849-2826
Mailing Address - Street 1:222 BELLEVUE AVE
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:RI
Mailing Address - Zip Code:02840-3515
Mailing Address - Country:US
Mailing Address - Phone:401-849-2826
Mailing Address - Fax:401-847-1695
Practice Address - Street 1:222 BELLEVUE AVE
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:RI
Practice Address - Zip Code:02840-3515
Practice Address - Country:US
Practice Address - Phone:401-849-2826
Practice Address - Fax:401-847-1695
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-20
Last Update Date:2008-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI4796208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty