Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | D0052235 | MD |
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | D0052235 | MD |
NPI | 1134154248 |
---|---|
Provider Name | Mr. Vincent Joseph Rollo |
First Address | Westminster, MD 21158-0900 |
Second Address | Westminster, MD 21157-6664 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2006 |
Last Update Date | 04/02/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
471610800 | (05) | MD |