Provider Demographics
NPI:1578504676
Name:ROTHMAN, KEITH STUART (MD)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:STUART
Last Name:ROTHMAN
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 1:680 HEACOCK RD
Mailing Address - Street 2:STE202
Mailing Address - City:YARDLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19067-6346
Mailing Address - Country:US
Mailing Address - Phone:215-493-1000
Mailing Address - Fax:
Practice Address - Street 1:680 HEACOCK RD
Practice Address - Street 2:STE202
Practice Address - City:YARDLEY
Practice Address - State:PA
Practice Address - Zip Code:19067-6346
Practice Address - Country:US
Practice Address - Phone:215-493-1000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-09
Last Update Date:2009-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD030707E207R00000X
NJMA41042207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA117251Medicare ID - Type Unspecified
PAB37042Medicare UPIN