Basic Information
Provider Information
NPI: 1700107075
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ROTTA
FirstName: MARCELLO
MiddleName: M
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 4900 S MONACO ST STE 210
Address2: DENVER
City: DENVER
State: CO
PostalCode: 802373487
CountryCode: US
TelephoneNumber: 7207544800
FaxNumber: 7207544801
Practice Location
Address1: 1721 E 19TH AVE STE 300
Address2: DENVER
City: DENVER
State: CO
PostalCode: 802181258
CountryCode: US
TelephoneNumber: 7207544800
FaxNumber: 7207544801
Other Information
ProviderEnumerationDate: 06/21/2010
LastUpdateDate: 09/19/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RH0003X56866COY Allopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology

No ID Information.


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