Individual
VINCENT EDWARD MORTELLARO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1600 7TH AVE S, BIRMINGHAM, AL 35233-1711
(205) 939-9100
Mailing address
PO BOX 55310, BIRMINGHAM, AL 35255-5310
(205) 731-9701
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
TRN8848
FL
2086S0120X
Pediatric Surgery Physician
Primary
30918
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01356513
—
MS
01
—
051117802
BCBS
AL
01
—
051117803
BCBS
AL
01
—
051117804
BCBS
AL
01
—
051117806
BCBS
AL
05
—
129871
—
AL
05
—
129872
—
AL
05
—
129873
—
AL
05
—
129875
—
AL
Enumeration date
12/04/2006
Last updated
10/11/2011
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