Provider Demographics
NPI:1295914067
Name:OTTONELLO RHEUMATOLOGY LLC
Entity type:Organization
Organization Name:OTTONELLO RHEUMATOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DOMINGO
Authorized Official - Middle Name:G
Authorized Official - Last Name:OTTONELLO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:412-673-8110
Mailing Address - Street 1:500 NAYSMITH ROAD
Mailing Address - Street 2:
Mailing Address - City:NORTH VERSAILLES
Mailing Address - State:PA
Mailing Address - Zip Code:15137-2340
Mailing Address - Country:US
Mailing Address - Phone:412-673-8110
Mailing Address - Fax:412-673-6223
Practice Address - Street 1:500 NAYSMITH ROAD
Practice Address - Street 2:
Practice Address - City:NORTH VERSAILLES
Practice Address - State:PA
Practice Address - Zip Code:15137-2340
Practice Address - Country:US
Practice Address - Phone:412-673-8110
Practice Address - Fax:412-673-6223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-30
Last Update Date:2015-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018106130002Medicaid
PA0018106130002Medicaid