Provider Demographics
NPI:1386136745
Name:BARTOLOTTA, DAVID ANTHONY JR (ATC, EMT)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:ANTHONY
Last Name:BARTOLOTTA
Suffix:JR
Gender:M
Credentials:ATC, EMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 HIDDEN LAKE RD
Mailing Address - Street 2:
Mailing Address - City:HIGGANUM
Mailing Address - State:CT
Mailing Address - Zip Code:06441-4527
Mailing Address - Country:US
Mailing Address - Phone:860-754-7341
Mailing Address - Fax:
Practice Address - Street 1:160 HIDDEN LAKE RD
Practice Address - Street 2:
Practice Address - City:HIGGANUM
Practice Address - State:CT
Practice Address - Zip Code:06441-4527
Practice Address - Country:US
Practice Address - Phone:860-754-7341
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-01
Last Update Date:2018-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000864207PS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PS0010XAllopathic & Osteopathic PhysiciansEmergency MedicineSports Medicine