Provider Demographics
NPI:1528044229
Name:ROTTER, STEVEN M (MD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:M
Last Name:ROTTER
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 1:112 VIA VERDE WAY
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33418-6205
Mailing Address - Country:US
Mailing Address - Phone:973-625-0600
Mailing Address - Fax:973-625-3434
Practice Address - Street 1:715 W BOYNTON BEACH BLVD STE C
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33426-3625
Practice Address - Country:US
Practice Address - Phone:561-737-8376
Practice Address - Fax:561-509-7068
Is Sole Proprietor?:No
Enumeration Date:2005-12-15
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101047774207N00000X, 207ND0101X
FLME104496207ND0101X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAP00137154OtherRAILROAD MEDICARE
F26593Medicare UPIN
VAG01426001Medicare PIN