Healthcare Provider Details

I. General information

NPI: 1760431233
Provider Name (Legal Business Name): MARC E ROTHENBERG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 04/10/2020
Certification Date: 04/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 BURNET AVE MLC 2000
CINCINNATI OH
45229-3039
US

IV. Provider business mailing address

MLC 5021 3333 BURNET AVE
CINCINNATI OH
45229-3039
US

V. Phone/Fax

Practice location:
  • Phone: 513-636-6771
  • Fax:
Mailing address:
  • Phone: 513-636-4225
  • Fax: 513-636-2511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number35.072107
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code2080P0201X
TaxonomyPediatric Allergy/Immunology Physician
License Number35.072107
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: