Provider Demographics
NPI:1033163910
Name:ROTHMAN, JASON S (MD)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:S
Last Name:ROTHMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:50 STANIFORD ST
Mailing Address - Street 2:SUITE 600
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114-2517
Mailing Address - Country:US
Mailing Address - Phone:617-367-4800
Mailing Address - Fax:617-723-7028
Practice Address - Street 1:50 STANIFORD ST
Practice Address - Street 2:SUITE 600
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2517
Practice Address - Country:US
Practice Address - Phone:617-367-4800
Practice Address - Fax:617-723-7028
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2015-12-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA155168207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110038800AMedicaid
MA2076748Medicaid
MAH66866Medicare UPIN
MA2076748Medicaid
MAA3439701Medicare PIN