Provider Demographics
NPI:1710692074
Name:BERTOLOTTI, RAQUEL MARQUES (PA-C)
Entity Type:Individual
Prefix:
First Name:RAQUEL
Middle Name:MARQUES
Last Name:BERTOLOTTI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1598 S COUNTY TRL STE 202
Mailing Address - Street 2:
Mailing Address - City:EAST GREENWICH
Mailing Address - State:RI
Mailing Address - Zip Code:02818-1762
Mailing Address - Country:US
Mailing Address - Phone:401-886-5663
Mailing Address - Fax:401-884-9043
Practice Address - Street 1:1598 S COUNTY TRL STE 202
Practice Address - Street 2:
Practice Address - City:EAST GREENWICH
Practice Address - State:RI
Practice Address - Zip Code:02818-1762
Practice Address - Country:US
Practice Address - Phone:401-886-5663
Practice Address - Fax:401-884-9043
Is Sole Proprietor?:No
Enumeration Date:2023-01-20
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant