Healthcare Provider Details

I. General information

NPI: 1942813720
Provider Name (Legal Business Name): DAVID ROTHMAN PH.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2020
Last Update Date: 08/31/2020
Certification Date: 08/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 WILKES DRIVE
RICHOMD VA
23233
US

IV. Provider business mailing address

2202 8TH AVE UNIT 701
SEATTLE WA
98121-2089
US

V. Phone/Fax

Practice location:
  • Phone: 804-877-4000
  • Fax:
Mailing address:
  • Phone: 609-405-0960
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0810007030
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: