Provider Demographics
NPI:1972570422
Name:ROTONDO, KATHLEEN MARY (MD)
Entity Type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:MARY
Last Name:ROTONDO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:593 EDDY ST
Mailing Address - Street 2:HASBRO 122
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02903-4923
Mailing Address - Country:US
Mailing Address - Phone:401-444-6484
Mailing Address - Fax:401-444-6378
Practice Address - Street 1:1 HOPPIN ST
Practice Address - Street 2:PEDIATRIC HEART CENTER; SUITE 304
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02903-4141
Practice Address - Country:US
Practice Address - Phone:401-444-4612
Practice Address - Fax:401-793-8831
Is Sole Proprietor?:No
Enumeration Date:2006-03-03
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
RIMD112922080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIKR50807Medicaid
RIKR50807Medicaid
RI007050060Medicare PIN