Provider Demographics
NPI:1821031279
Name:ROTHMAN, CYNTHIA LENORE (PA)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:LENORE
Last Name:ROTHMAN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1305 AIRPORT FWY STE 320
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76021-1116
Mailing Address - Country:US
Mailing Address - Phone:817-684-3500
Mailing Address - Fax:817-684-3510
Practice Address - Street 1:1305 AIRPORT FWY STE 320
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76021-1116
Practice Address - Country:US
Practice Address - Phone:817-684-3500
Practice Address - Fax:817-684-3510
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2019-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA02966363A00000X
TXPA01978363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX377422601Medicaid
TXS61387Medicare UPIN