Provider Demographics
NPI:1073526919
Name:ROTHENBERG, ROBERT A (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:A
Last Name:ROTHENBERG
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:4 FARM SPRINGS RD
Mailing Address - Street 2:PROHEALTH PHYSICIANS
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06032-2573
Mailing Address - Country:US
Mailing Address - Phone:860-284-5200
Mailing Address - Fax:860-284-5333
Practice Address - Street 1:21 ARTS CENTER COURT
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:CT
Practice Address - Zip Code:06001-3680
Practice Address - Country:US
Practice Address - Phone:860-674-9686
Practice Address - Fax:860-674-9954
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2007-07-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CT018176207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTE38528Medicare UPIN