Provider Demographics
NPI:1366495442
Name:DAVID L. ROTHMAN, MD, PC
Entity Type:Organization
Organization Name:DAVID L. ROTHMAN, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:BECKY
Authorized Official - Middle Name:L
Authorized Official - Last Name:LINDEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-458-5730
Mailing Address - Street 1:PO BOX 347
Mailing Address - Street 2:
Mailing Address - City:GROVE CITY
Mailing Address - State:PA
Mailing Address - Zip Code:16127-0347
Mailing Address - Country:US
Mailing Address - Phone:724-458-5730
Mailing Address - Fax:724-458-0179
Practice Address - Street 1:647 N BROAD STREET EXT
Practice Address - Street 2:STE 205
Practice Address - City:GROVE CITY
Practice Address - State:PA
Practice Address - Zip Code:16127-4604
Practice Address - Country:US
Practice Address - Phone:724-458-5730
Practice Address - Fax:724-458-0179
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD019857E208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01425285Medicaid
PA72583Medicare ID - Type Unspecified
PA072583GS4Medicare ID - Type Unspecified
PA01425285Medicaid