Provider Demographics
NPI:1447310750
Name:CRITICAL CARE ASSOCIATES, LLC
Entity type:Organization
Organization Name:CRITICAL CARE ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LEO
Authorized Official - Middle Name:C
Authorized Official - Last Name:ROTELLO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:800-655-2656
Mailing Address - Street 1:PO BOX 79599
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21279-0599
Mailing Address - Country:US
Mailing Address - Phone:800-655-2656
Mailing Address - Fax:412-822-7411
Practice Address - Street 1:400 W 7TH ST
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-4506
Practice Address - Country:US
Practice Address - Phone:240-566-3300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2008-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD412897400Medicaid
MD78TZCROtherCAREFIRST BCBS
DC7496OtherCAREFIRST BCBS
MD412897400Medicaid
MDDG1484Medicare PIN