MEDICARE: GERSON BARRY ROTHMAN MD

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	2085R0202X	Diagnostic Radiology Physician	MD009498E	PA

General Provider Information

NPI Number	:	1134388622
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GERSON BARRY ROTHMAN MD

Provider Business Mailing Address
First Line	:	208 PINE ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19106-4314
Country	:	US
Telephone Number	:	215-928-8845
Fax Number	:

Provider Business Practice Location Address
First Line	:	208 PINE ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19106-4314
Country	:	US
Telephone Number	:	215-928-8845
Fax Number	:

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

Provider Enumeration Date	:	06/09/2008
Last Update Date	:	06/09/2008

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