MEDICARE: MEGHAN B ROTHROCK

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	363LP0200X	Pediatric Nurse Practitioner	383040	NY

General Provider Information

NPI Number	:	1528612892
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEGHAN B ROTHROCK

Provider Business Mailing Address
First Line	:	42 GUNPOWDER DR UNIT 2166
Second Line	:
City	:	ATHENS
State	:	NY
Zip	:	12015-4205
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	159 JEFFERSON HTS STE C103
Second Line	:
City	:	CATSKILL
State	:	NY
Zip	:	12414-1204
Country	:	US
Telephone Number	:	518-943-2557
Fax Number	:

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

Provider Enumeration Date	:	07/25/2019
Last Update Date	:	07/25/2019

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Directions to “ MEGHAN B ROTHROCK ” Practice Location

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