Provider Demographics
NPI:1245285667
Name:TORTOLANI, ROBERT EDMUND (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:EDMUND
Last Name:TORTOLANI
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 1:63 BELMONT AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:BRATTLEBORO
Mailing Address - State:VT
Mailing Address - Zip Code:05301-6614
Mailing Address - Country:US
Mailing Address - Phone:802-254-1113
Mailing Address - Fax:
Practice Address - Street 1:63 BELMONT AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:BRATTLEBORO
Practice Address - State:VT
Practice Address - Zip Code:05301-6614
Practice Address - Country:US
Practice Address - Phone:802-254-1113
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-24
Last Update Date:2009-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT042-0004283207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT00004509OtherBLUE CROSS BLUE SHIELD
0107454YPVT01OtherANTHEM
2436727OtherAETNA
63E51OtherEMPIRE BCBS
VT0004509Medicaid
710793OtherTUFTS
101335600OtherU.S. DEPT. OF LABOR
NH99903023Medicaid
B85462OtherHARVARD PILGRIM OF N.E.
B85462OtherTODAYS OPTIONS
030236149OtherCIGNA HEALTHCARE
082092003OtherRAILROAD MEDICARE
08P019OtherMVP
030236149OtherTRICARE
VT8000388OtherLADIES FIRST
VTVT4509Medicare PIN
030236149OtherTRICARE
VT4509Medicare ID - Type Unspecified