Provider Demographics
NPI:1659375475
Name:ROTHSCHILD, PETER (MD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:
Last Name:ROTHSCHILD
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 1:724 VIA PALO ALTO
Mailing Address - Street 2:STE 5
Mailing Address - City:APTOS
Mailing Address - State:CA
Mailing Address - Zip Code:95003-5629
Mailing Address - Country:US
Mailing Address - Phone:502-429-6500
Mailing Address - Fax:502-429-0770
Practice Address - Street 1:7807 SHELBYVILLE RD
Practice Address - Street 2:STE 100
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40222-5495
Practice Address - Country:US
Practice Address - Phone:502-429-6500
Practice Address - Fax:502-429-0770
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2015-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY219262085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACA112100Medicare PIN
E56192Medicare UPIN