MEDICARE: DR. PHILIP ANDREW ROTHBERG MD, MPH&TM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	0101254601	VA
2	208600000X	Surgery Physician	ME148056	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1093077307
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PHILIP ANDREW ROTHBERG MD, MPH&TM

Provider Business Mailing Address
First Line	:	11945 SAN JOSE BLVD STE 300
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32223-1627
Country	:	US
Telephone Number	:	904-396-1725
Fax Number	:	904-396-4893

Provider Business Practice Location Address
First Line	:	300 SAINT ELIZABETH WAY STE 230
Second Line	:
City	:	ST JOHNS
State	:	FL
Zip	:	32259-1153
Country	:	US
Telephone Number	:	904-389-8861
Fax Number	:	904-396-4893

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/12/2012
Last Update Date	:	01/24/2024

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