Provider Demographics
NPI:1699715151
Name:QUATELA, VITO CHARLES (MD)
Entity type:Individual
Prefix:DR
First Name:VITO
Middle Name:CHARLES
Last Name:QUATELA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:973 EAST AVE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14607-2216
Mailing Address - Country:US
Mailing Address - Phone:585-244-1000
Mailing Address - Fax:585-271-4786
Practice Address - Street 1:973 EAST AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14607-2216
Practice Address - Country:US
Practice Address - Phone:585-244-1000
Practice Address - Fax:585-271-4786
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2016-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY147025207YX0905X, 2082S0099X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2082S0099XAllopathic & Osteopathic PhysiciansPlastic SurgeryPlastic Surgery Within the Head and Neck
No207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYB76830Medicare UPIN