Provider Demographics
NPI:1245319136
Name:ROTO, DOMINICK F II (DO FAAFP)
Entity type:Individual
Prefix:DR
First Name:DOMINICK
Middle Name:F
Last Name:ROTO
Suffix:II
Gender:M
Credentials:DO FAAFP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 POMFRET ST
Mailing Address - Street 2:
Mailing Address - City:PUTNAM
Mailing Address - State:CT
Mailing Address - Zip Code:06260-1803
Mailing Address - Country:US
Mailing Address - Phone:860-928-5248
Mailing Address - Fax:860-928-5286
Practice Address - Street 1:145 POMFRET ST
Practice Address - Street 2:
Practice Address - City:PUTNAM
Practice Address - State:CT
Practice Address - Zip Code:06260
Practice Address - Country:US
Practice Address - Phone:860-928-5248
Practice Address - Fax:860-928-5286
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2015-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000328207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT040000328CJ01OtherBCBS
2962295OtherAETNA
CT001003285Medicaid
CT001003285Medicaid