Provider Demographics
NPI:1750558045
Name:ROTHMAN, RICHARD B (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:B
Last Name:ROTHMAN
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12719 FOLLY QUARTER RD
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-1275
Mailing Address - Country:US
Mailing Address - Phone:703-359-9200
Mailing Address - Fax:866-467-9404
Practice Address - Street 1:3923 OLD LEE HWY
Practice Address - Street 2:SUITE 61A
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-2428
Practice Address - Country:US
Practice Address - Phone:703-359-9200
Practice Address - Fax:866-467-9404
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-15
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD343822084B0002X, 2084P0800X
VA01010402202084B0002X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084B0002XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyObesity Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F22057Medicare UPIN