Provider Demographics
NPI:1083668362
Name:ROTHERMEL, WILLIAM S JR (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:S
Last Name:ROTHERMEL
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4885 OLENTANGY RIVER RD
Mailing Address - Street 2:STE 230
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43214
Mailing Address - Country:US
Mailing Address - Phone:614-451-3388
Mailing Address - Fax:614-451-1048
Practice Address - Street 1:4885 OLENTANGY RIVER RD
Practice Address - Street 2:STE 230
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214
Practice Address - Country:US
Practice Address - Phone:614-451-3388
Practice Address - Fax:614-451-1048
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35036348R208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0371431Medicaid
OH4018581Medicare ID - Type Unspecified
OH0371431Medicaid