Provider Demographics
NPI:1023314275
Name:ROTHKO, KATE (MD)
Entity type:Individual
Prefix:
First Name:KATE
Middle Name:
Last Name:ROTHKO
Suffix:
Gender:F
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:P.O. BOX 596
Mailing Address - Street 2:154 MILLERTON ROAD
Mailing Address - City:LAKEVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06039
Mailing Address - Country:US
Mailing Address - Phone:860-435-9814
Mailing Address - Fax:
Practice Address - Street 1:154 MILLERTON ROAD
Practice Address - Street 2:
Practice Address - City:LAKEVILLE
Practice Address - State:CT
Practice Address - Zip Code:06039
Practice Address - Country:US
Practice Address - Phone:860-435-9814
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-07
Last Update Date:2013-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0024920174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist