Healthcare Provider Details

I. General information

NPI: 1508989963
Provider Name (Legal Business Name): LARRY A ROTENBERG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2007
Last Update Date: 05/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2201 RIDGEWOOD RD SUITE 400
WYOMISSING PA
19610-1189
US

IV. Provider business mailing address

PO BOX 16052
READING PA
19612-6052
US

V. Phone/Fax

Practice location:
  • Phone: 610-378-9601
  • Fax: 610-378-9061
Mailing address:
  • Phone: 610-988-9041
  • Fax: 610-988-9080

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code173000000X
TaxonomyLegal Medicine
License NumberMD008227E
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: