Provider Demographics
NPI:1366677874
Name:ROTHGERY, MARC CHAGALL (MD)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:CHAGALL
Last Name:ROTHGERY
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 1:1223 E 600 S
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84102-3202
Mailing Address - Country:US
Mailing Address - Phone:518-258-6881
Mailing Address - Fax:
Practice Address - Street 1:1223 E 600 S
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84102-3202
Practice Address - Country:US
Practice Address - Phone:518-258-6881
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-28
Last Update Date:2009-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program