Provider Demographics
NPI:1811282981
Name:BOTTARO, VINCENT ANTHONY (PA-C)
Entity type:Individual
Prefix:MR
First Name:VINCENT
Middle Name:ANTHONY
Last Name:BOTTARO
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7801 YORK RD STE 305
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-7449
Mailing Address - Country:US
Mailing Address - Phone:410-583-5677
Mailing Address - Fax:410-583-5680
Practice Address - Street 1:7801 YORK RD STE 305
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-7449
Practice Address - Country:US
Practice Address - Phone:410-583-5677
Practice Address - Fax:410-583-5680
Is Sole Proprietor?:No
Enumeration Date:2011-06-16
Last Update Date:2025-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0005422363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA324481Medicare PIN