Provider Demographics
NPI:1700232477
Name:ROTHBERG, MICHAEL BRYAN (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:BRYAN
Last Name:ROTHBERG
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 1:40 DUKE MEDICINE CIRCLE
Mailing Address - Street 2:DUMC 3707
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27710
Mailing Address - Country:US
Mailing Address - Phone:919-681-8760
Mailing Address - Fax:
Practice Address - Street 1:DUKE CANCER CENTER GENITOURINARY CLINIC 5-1
Practice Address - Street 2:20 DUKE MEDICINE CIRCLE
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27710
Practice Address - Country:US
Practice Address - Phone:919-668-6688
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-11
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2023-02682208800000X
MDD0092145208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology