Healthcare Provider Details

I. General information

NPI: 1003900499
Provider Name (Legal Business Name): THOMAS ROTHFELD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 07/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 SAN MATEO BLVD SE PMG SAN MATEO
ALBUQUERQUE NM
87108-2921
US

IV. Provider business mailing address

PO BOX 26666 PHS PROVIDER ENROLLMENT
ALBUQUERQUE NM
87125-6666
US

V. Phone/Fax

Practice location:
  • Phone: 505-462-7306
  • Fax: 505-462-7495
Mailing address:
  • Phone: 505-923-5356
  • Fax: 505-923-5654

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number90108
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: