Provider Demographics
NPI:1346203866
Name:ROTHSCHILD, ELLIOT S (MD)
Entity Type:Individual
Prefix:
First Name:ELLIOT
Middle Name:S
Last Name:ROTHSCHILD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4000 OLD COURT RD
Mailing Address - Street 2:STE 301
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21208
Mailing Address - Country:US
Mailing Address - Phone:410-653-0000
Mailing Address - Fax:410-653-0798
Practice Address - Street 1:4000 OLD COURT RD
Practice Address - Street 2:STE 301
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21208
Practice Address - Country:US
Practice Address - Phone:410-653-0000
Practice Address - Fax:410-653-0798
Is Sole Proprietor?:No
Enumeration Date:2006-04-07
Last Update Date:2009-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD51426207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME323503300Medicaid
G75590Medicare UPIN
ME323503300Medicaid