Provider Demographics
NPI:1215335849
Name:MAROTTOLO, THOMAS
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:
Last Name:MAROTTOLO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4500 MACDONALD AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:CA
Mailing Address - Zip Code:94805-2307
Mailing Address - Country:US
Mailing Address - Phone:510-253-1001
Mailing Address - Fax:510-253-1011
Practice Address - Street 1:4500 MACDONALD AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:CA
Practice Address - Zip Code:94805-2307
Practice Address - Country:US
Practice Address - Phone:510-253-1001
Practice Address - Fax:510-253-1011
Is Sole Proprietor?:No
Enumeration Date:2014-12-13
Last Update Date:2014-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA64715183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist