Provider Demographics
NPI:1093773947
Name:ROTHSCHILD, JEFFREY MARK (MD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:MARK
Last Name:ROTHSCHILD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:141 WOOD END ROAD
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02461
Mailing Address - Country:US
Mailing Address - Phone:617-732-4825
Mailing Address - Fax:617-732-7072
Practice Address - Street 1:2014 WASHINGTON STREET
Practice Address - Street 2:NEWTON- WELLESLEY HOSPITAL
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02462
Practice Address - Country:US
Practice Address - Phone:617-243-6433
Practice Address - Fax:617-243-5148
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA157904207RC0200X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Not Answered208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3149536Medicaid
MAJ22069OtherBCBS
A30580Medicare UPIN
C28908Medicare ID - Type Unspecified