Provider Demographics
NPI:1013915925
Name:ROTHSTEIN, LAURENCE ROSS (MD)
Entity Type:Individual
Prefix:DR
First Name:LAURENCE
Middle Name:ROSS
Last Name:ROTHSTEIN
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 1:7677 MORAINE RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:VERONA
Mailing Address - State:WI
Mailing Address - Zip Code:53593-8629
Mailing Address - Country:US
Mailing Address - Phone:608-829-1544
Mailing Address - Fax:
Practice Address - Street 1:202 SOUTH PARK STREET
Practice Address - Street 2:C/O MADISON ANESTHESIOLOGY CONSULTANTS, LLP
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53715
Practice Address - Country:US
Practice Address - Phone:608-267-6676
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI27313207L00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32896400/31584700Medicaid
WI32896400/31584700Medicaid