Healthcare Provider Details

I. General information

NPI: 1639176027
Provider Name (Legal Business Name): JAN M ROTHMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2005
Last Update Date: 03/31/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 W. 12TH ST THE REGIONAL CANCER CTR
ERIE PA
16505
US

IV. Provider business mailing address

2500 W 12TH ST THE REGIONAL CANCER CENTER
ERIE PA
16505-4508
US

V. Phone/Fax

Practice location:
  • Phone: 814-838-9000
  • Fax: 814-838-0443
Mailing address:
  • Phone: 814-838-9000
  • Fax: 814-838-0462

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberMD054402
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: