Provider Demographics
NPI:1952309213
Name:ROTHMAN, MICHAEL IAN (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:IAN
Last Name:ROTHMAN
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 1:23625 COMMERCE PARK
Mailing Address - Street 2:SUITE 204
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-5845
Mailing Address - Country:US
Mailing Address - Phone:216-255-5700
Mailing Address - Fax:216-255-5701
Practice Address - Street 1:870 WAFFORD LANE
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18017-3876
Practice Address - Country:US
Practice Address - Phone:216-255-5700
Practice Address - Fax:216-255-5701
Is Sole Proprietor?:No
Enumeration Date:2005-07-11
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360788722085R0202X
MDD00369112085N0700X
PAMD039205E2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMD039205EOtherLICENSE
PA0017172610016Medicaid
021449XREOtherPENNSYLVANIA MEDICARE
CT043597OtherLICENSE
PA881901OtherHIGHMARK
PA1012411910001Medicaid
NJ8962103Medicaid
DEC1-0007404OtherLICENSE
NY239105-1OtherLICENSE
NJ25MA08035800OtherLICENSE
NY02906701Medicaid
MDD003691OtherLICENSE
MDD003691OtherLICENSE
MDD003691OtherLICENSE
PA881901OtherHIGHMARK
PA021449P29Medicare PIN
NJ8962103Medicaid
BR1924009OtherDEA
E91821Medicare UPIN