Healthcare Provider Details

I. General information

NPI: 1952309213
Provider Name (Legal Business Name): MICHAEL IAN ROTHMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2005
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

870 WAFFORD LANE
BETHLEHEM PA
18017-3876
US

IV. Provider business mailing address

23625 COMMERCE PARK SUITE 204
BEACHWOOD OH
44122-5845
US

V. Phone/Fax

Practice location:
  • Phone: 216-255-5700
  • Fax: 216-255-5701
Mailing address:
  • Phone: 216-255-5700
  • Fax: 216-255-5701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License NumberD0036911
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number036078872
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD039205E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: