Provider Demographics
NPI:1629079314
Name:ROTHMAN, JULIE A (DO)
Entity Type:Individual
Prefix:MS
First Name:JULIE
Middle Name:A
Last Name:ROTHMAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:MS
Other - First Name:JULIE
Other - Middle Name:A
Other - Last Name:ROTHMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:205 GRANDVIEW AVE
Mailing Address - Street 2:SUITE 402
Mailing Address - City:CAMP HILL
Mailing Address - State:PA
Mailing Address - Zip Code:17011-1708
Mailing Address - Country:US
Mailing Address - Phone:717-972-2800
Mailing Address - Fax:717-972-2845
Practice Address - Street 1:205 GRANDVIEW AVE
Practice Address - Street 2:SUITE 402
Practice Address - City:CAMP HILL
Practice Address - State:PA
Practice Address - Zip Code:17011-1708
Practice Address - Country:US
Practice Address - Phone:717-972-2800
Practice Address - Fax:717-972-2845
Is Sole Proprietor?:No
Enumeration Date:2005-08-03
Last Update Date:2014-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS005510L207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
1629079314OtherNPI
PA00112581140006Medicaid
PA00112581140006Medicaid
168572PZ7Medicare PIN