Healthcare Provider Details

I. General information

NPI: 1578504676
Provider Name (Legal Business Name): KEITH STUART ROTHMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 12/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

680 HEACOCK RD STE202
YARDLEY PA
19067-6346
US

IV. Provider business mailing address

680 HEACOCK RD STE202
YARDLEY PA
19067-6346
US

V. Phone/Fax

Practice location:
  • Phone: 215-493-1000
  • Fax:
Mailing address:
  • Phone: 215-493-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD030707E
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMA41042
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: