Healthcare Provider Details

I. General information

NPI: 1669933487
Provider Name (Legal Business Name): WILLIAM THOMAS ROTHWELL MD PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2019
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 NORTHERN AVE
BOSTON MA
02210-1862
US

IV. Provider business mailing address

336 CHELSEA ST UNIT 6
EAST BOSTON MA
02128-5001
US

V. Phone/Fax

Practice location:
  • Phone: 857-276-5490
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZC0006X
TaxonomyClinical Pathology Physician
License Number1014255
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: