Provider Demographics
NPI:1821024761
Name:ROTHENBERG, MARK D (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:D
Last Name:ROTHENBERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:5700 LAKE WORTH RD STE 204
Mailing Address - Street 2:
Mailing Address - City:GREENACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33463-3213
Mailing Address - Country:US
Mailing Address - Phone:561-966-7717
Mailing Address - Fax:561-649-7028
Practice Address - Street 1:5503 S CONGRESS AVE
Practice Address - Street 2:STE 206
Practice Address - City:ATLANTIS
Practice Address - State:FL
Practice Address - Zip Code:33462-6625
Practice Address - Country:US
Practice Address - Phone:561-433-0591
Practice Address - Fax:561-433-0891
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2017-12-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME70659207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL060058236OtherRAILROAD MEDICARE
FL250904100Medicaid
FL31931OtherBCBS
FL31931ZMedicare PIN
FL31931YMedicare PIN
G28212Medicare UPIN