Provider Demographics
NPI:1871529727
Name:ROTONDO, R. LOUIS (DPM)
Entity type:Individual
Prefix:DR
First Name:R.
Middle Name:LOUIS
Last Name:ROTONDO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:990 PARADISE RD
Mailing Address - Street 2:SUITE 1B
Mailing Address - City:SWAMPSCOTT
Mailing Address - State:MA
Mailing Address - Zip Code:01907-1395
Mailing Address - Country:US
Mailing Address - Phone:781-581-2105
Mailing Address - Fax:781-593-3883
Practice Address - Street 1:990 PARADISE RD
Practice Address - Street 2:SUITE 1B
Practice Address - City:SWAMPSCOTT
Practice Address - State:MA
Practice Address - Zip Code:01907-1395
Practice Address - Country:US
Practice Address - Phone:781-581-2105
Practice Address - Fax:781-593-3883
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA1595213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY70666OtherBLUE SHEILD OF MA
MA33614OtherHARVARD PILGRIM HEALTH
MA32577OtherFALLON HEALTH PLAN
MA0361259Medicaid
MA721116OtherTUFTS HEALTH PLAN
MAY70666Medicare PIN
MA721116OtherTUFTS HEALTH PLAN
MA480019179Medicare PIN