Provider Demographics
NPI:1639176027
Name:ROTHMAN, JAN M (MD)
Entity Type:Individual
Prefix:
First Name:JAN
Middle Name:M
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 1:2500 W 12TH ST
Mailing Address - Street 2:THE REGIONAL CANCER CENTER
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16505-4508
Mailing Address - Country:US
Mailing Address - Phone:814-838-9000
Mailing Address - Fax:814-838-0462
Practice Address - Street 1:2500 W. 12TH ST
Practice Address - Street 2:THE REGIONAL CANCER CTR
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16505
Practice Address - Country:US
Practice Address - Phone:814-838-9000
Practice Address - Fax:814-838-0443
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2010-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD054402207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0015075870001Medicaid
PA670635OtherHIGHMARK
OH0127400Medicaid
0159OtherPA BLUE CROSS
140052OtherPA MCR GR#
OH0127400Medicaid
PA0015075870001Medicaid
PA670635FYNMedicare PIN