MEDICARE: DR. ELLEN N. ROTHCHILD M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	22715	OH

General Provider Information

NPI Number	:	1073526067
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELLEN N. ROTHCHILD M.D.

Provider Business Mailing Address
First Line	:	1970 DENTON DR
Second Line	:
City	:	CLEVELAND HEIGHTS
State	:	OH
Zip	:	44106-4604
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1970 DENTON DR
Second Line	:
City	:	CLEVELAND HEIGHTS
State	:	OH
Zip	:	44106-4604
Country	:	US
Telephone Number	:	216-321-2043
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/14/2006
Last Update Date	:	02/08/2008

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