Provider Demographics
NPI:1881653004
Name:ROTHFUSS, HENRY LESTER (MD)
Entity Type:Individual
Prefix:DR
First Name:HENRY
Middle Name:LESTER
Last Name:ROTHFUSS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2115 EXECUTIVE DR
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23666-2499
Mailing Address - Country:US
Mailing Address - Phone:757-827-1920
Mailing Address - Fax:757-827-7509
Practice Address - Street 1:2115 EXECUTIVE DR
Practice Address - Street 2:SUITE 2A
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-2499
Practice Address - Country:US
Practice Address - Phone:757-827-1920
Practice Address - Fax:757-827-7509
Is Sole Proprietor?:No
Enumeration Date:2006-03-18
Last Update Date:2007-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101033520207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAB06789Medicare UPIN