Provider Demographics
NPI:1710185681
Name:MORTARELLI, ETTORE ANDREW (MD)
Entity Type:Individual
Prefix:DR
First Name:ETTORE
Middle Name:ANDREW
Last Name:MORTARELLI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 BEDFORD ST
Mailing Address - Street 2:
Mailing Address - City:WEST BRIDGEWATER
Mailing Address - State:MA
Mailing Address - Zip Code:02379-1705
Mailing Address - Country:US
Mailing Address - Phone:508-584-9950
Mailing Address - Fax:
Practice Address - Street 1:117 BEDFORD ST
Practice Address - Street 2:
Practice Address - City:WEST BRIDGEWATER
Practice Address - State:MA
Practice Address - Zip Code:02379-1705
Practice Address - Country:US
Practice Address - Phone:508-584-9950
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5289227900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered