Provider Demographics
NPI:1174315790
Name:BHETHANABOTLA, ROHITH MADHIRA (MD)
Entity type:Individual
Prefix:
First Name:ROHITH
Middle Name:MADHIRA
Last Name:BHETHANABOTLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:633 W RITTENHOUSE ST APT B1208
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19144-4388
Mailing Address - Country:US
Mailing Address - Phone:669-307-1780
Mailing Address - Fax:
Practice Address - Street 1:3401 N BROAD ST FL 6
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19140-5189
Practice Address - Country:US
Practice Address - Phone:800-836-6533
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-20
Last Update Date:2025-05-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMT233669208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery