Healthcare Provider Details

I. General information

NPI: 1194147033
Provider Name (Legal Business Name): JONATHAN ROTHMAN, M.D.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2014
Last Update Date: 01/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 WILLIAM ST
WORCESTER MA
01609-2336
US

IV. Provider business mailing address

PO BOX 34
WESTBOROUGH MA
01581-0034
US

V. Phone/Fax

Practice location:
  • Phone: 508-791-5540
  • Fax: 508-799-6325
Mailing address:
  • Phone: 508-791-5540
  • Fax: 508-799-6325

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number116724
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MS. LAURA JACOBSON
Title or Position: OFFICE MANAGER
Credential:
Phone: 508-791-5540