1952309213 NPI number — MICHAEL IAN ROTHMAN MD

Table of content: MICHAEL IAN ROTHMAN MD (NPI 1952309213)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952309213 NPI number — MICHAEL IAN ROTHMAN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROTHMAN
Provider First Name:
MICHAEL
Provider Middle Name:
IAN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1952309213
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
23625 COMMERCE PARK
Provider Second Line Business Mailing Address:
SUITE 204
Provider Business Mailing Address City Name:
BEACHWOOD
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44122-5845
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
216-255-5700
Provider Business Mailing Address Fax Number:
216-255-5701

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
870 WAFFORD LANE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BETHLEHEM
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18017-3876
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
216-255-5700
Provider Business Practice Location Address Fax Number:
216-255-5701
Provider Enumeration Date:
07/11/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X , with the licence number:  036078872 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085N0700X , with the licence number: D0036911 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X , with the licence number: MD039205E , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: MD039205E . This is a "LICENSE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0017172610016 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 021449XRE . This is a "PENNSYLVANIA MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 043597 . This is a "LICENSE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 881901 . This is a "HIGHMARK" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1012411910001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8962103 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: C1-0007404 . This is a "LICENSE" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 239105-1 . This is a "LICENSE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 25MA08035800 . This is a "LICENSE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 02906701 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: D003691 . This is a "LICENSE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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