Provider Demographics
NPI:1770508053
Name:COLETTI, ROGER H (MD)
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:H
Last Name:COLETTI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:16529 COASTAL HWY
Mailing Address - Street 2:SUITE 125
Mailing Address - City:LEWES
Mailing Address - State:DE
Mailing Address - Zip Code:19958-3605
Mailing Address - Country:US
Mailing Address - Phone:302-645-1500
Mailing Address - Fax:302-258-0864
Practice Address - Street 1:16529 COASTAL HWY
Practice Address - Street 2:SUITE 125
Practice Address - City:LEWES
Practice Address - State:DE
Practice Address - Zip Code:19958-3605
Practice Address - Country:US
Practice Address - Phone:302-645-1500
Practice Address - Fax:302-258-0864
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2015-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY134677-1207RC0000X
DEC1-0008367207RC0000X
NJMA42243207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE356547ZJA2Medicare PIN
NJC53672Medicare UPIN
NJ164716CQ0Medicare PIN