Provider Demographics
NPI:1932102985
Name:ROTHSTEIN, MARK TERRY (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:TERRY
Last Name:ROTHSTEIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5450 FRANTZ RD STE 360
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43016-4141
Mailing Address - Country:US
Mailing Address - Phone:614-544-6155
Mailing Address - Fax:614-544-6370
Practice Address - Street 1:75 HOSPITAL DR
Practice Address - Street 2:SUITE 350
Practice Address - City:ATHENS
Practice Address - State:OH
Practice Address - Zip Code:45701-2857
Practice Address - Country:US
Practice Address - Phone:740-592-4491
Practice Address - Fax:740-592-4844
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2019-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD011535207Q00000X
OH35-037876207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0259134Medicaid
RO0408502OtherMEDICARE PROVIDER NUMBER
RO0408502OtherMEDICARE PROVIDER NUMBER
A75189Medicare UPIN
RO0408502Medicare ID - Type Unspecified