Healthcare Provider Details

I. General information

NPI: 1437844487
Provider Name (Legal Business Name): SAMUEL THOMAS ROTHSCHILD MSN, FNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2023
Last Update Date: 02/13/2025
Certification Date: 02/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 LINDALL ST
DANVERS MA
01923-2121
US

IV. Provider business mailing address

75 LINDALL ST
DANVERS MA
01923-2121
US

V. Phone/Fax

Practice location:
  • Phone: 978-223-9309
  • Fax: 484-971-4896
Mailing address:
  • Phone: 617-710-9414
  • Fax: 484-971-4896

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN2280566
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN2280566
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: