Provider Demographics
NPI:1770632341
Name:VON ROTTENTHALER, EDINA EVA (MD)
Entity Type:Individual
Prefix:
First Name:EDINA
Middle Name:EVA
Last Name:VON ROTTENTHALER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:613 MARTIN ST N STE 300
Mailing Address - Street 2:
Mailing Address - City:PELL CITY
Mailing Address - State:AL
Mailing Address - Zip Code:35125-1337
Mailing Address - Country:US
Mailing Address - Phone:205-338-6655
Mailing Address - Fax:205-338-6658
Practice Address - Street 1:2804 DR JOHN HAYNES DR
Practice Address - Street 2:
Practice Address - City:PELL CITY
Practice Address - State:AL
Practice Address - Zip Code:35125-1438
Practice Address - Country:US
Practice Address - Phone:205-338-6655
Practice Address - Fax:205-338-6658
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2019-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME103839207R00000X, 207RH0002X
ALMD.33284207RH0002X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine