Provider Demographics
NPI:1659674604
Name:ERIC S ROTHENBERG MD PA
Entity Type:Organization
Organization Name:ERIC S ROTHENBERG MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:A
Authorized Official - Last Name:PAYNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-998-9000
Mailing Address - Street 1:4500 E SAM HOUSTON PKWY S
Mailing Address - Street 2:SUITE 102
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77505-3959
Mailing Address - Country:US
Mailing Address - Phone:281-998-9000
Mailing Address - Fax:281-998-8001
Practice Address - Street 1:4500 E SAM HOUSTON PKWY S
Practice Address - Street 2:SUITE 102
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77505-3959
Practice Address - Country:US
Practice Address - Phone:281-998-9000
Practice Address - Fax:281-998-8001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-14
Last Update Date:2012-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ1029174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty