Provider Demographics
NPI:1831258953
Name:ROLLO, STEPHEN ANTHONY (MD)
Entity type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:ANTHONY
Last Name:ROLLO
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 1:91 ONEIDA ST
Mailing Address - Street 2:
Mailing Address - City:ONEONTA
Mailing Address - State:NY
Mailing Address - Zip Code:13820-2127
Mailing Address - Country:US
Mailing Address - Phone:607-432-0732
Mailing Address - Fax:607-432-0733
Practice Address - Street 1:91 ONEIDA ST
Practice Address - Street 2:
Practice Address - City:ONEONTA
Practice Address - State:NY
Practice Address - Zip Code:13820-2127
Practice Address - Country:US
Practice Address - Phone:607-432-0732
Practice Address - Fax:607-432-0733
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2011-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY186917207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY10020101OtherCDPHP
NY118100OtherMVP
NY118100OtherMVP
F13057Medicare UPIN