Healthcare Provider Details

I. General information

NPI: 1962720912
Provider Name (Legal Business Name): ALFRED J ROTHMAN M D PROF CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2010
Last Update Date: 08/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3021 DANA ST
BERKELEY CA
94705-2073
US

IV. Provider business mailing address

3021 DANA ST
BERKELEY CA
94705-2073
US

V. Phone/Fax

Practice location:
  • Phone: 510-845-2422
  • Fax: 510-845-7820
Mailing address:
  • Phone: 510-845-2422
  • Fax: 510-845-7820

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberC351770
License Number StateCA

VIII. Authorized Official

Name: ALFRED ROTHMAN
Title or Position: OWNER
Credential: MD
Phone: 510-845-2422