Provider Demographics
NPI:1508989963
Name:ROTENBERG, LARRY A (MD)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:A
Last Name:ROTENBERG
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:PO BOX 16052
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19612-6052
Mailing Address - Country:US
Mailing Address - Phone:610-988-9041
Mailing Address - Fax:610-988-9080
Practice Address - Street 1:2201 RIDGEWOOD RD
Practice Address - Street 2:SUITE 400
Practice Address - City:WYOMISSING
Practice Address - State:PA
Practice Address - Zip Code:19610-1189
Practice Address - Country:US
Practice Address - Phone:610-378-9601
Practice Address - Fax:610-378-9061
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2009-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD008227E173000000X
174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA031709XTGMedicare PIN
PAC28027Medicare UPIN
PA031709Medicare PIN