Provider Demographics
NPI:1538128897
Name:ROTTENBERG, HOWARD A (MD)
Entity Type:Individual
Prefix:DR
First Name:HOWARD
Middle Name:A
Last Name:ROTTENBERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:980 JOHNSON FERRY RD NE
Mailing Address - Street 2:SUITE 270
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-1626
Mailing Address - Country:US
Mailing Address - Phone:404-256-5332
Mailing Address - Fax:404-255-4513
Practice Address - Street 1:980 JOHNSON FERRY RD NE
Practice Address - Street 2:SUITE 270
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1626
Practice Address - Country:US
Practice Address - Phone:404-256-5332
Practice Address - Fax:404-255-4513
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2013-07-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA18543208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00134428BMedicaid
GA0365460002Medicare NSC
GA0365460001Medicare NSC
GA00134428BMedicaid