MEDICARE: CSP HLTH PSC

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	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1447048236
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CSP HLTH PSC

Provider Business Mailing Address
First Line	:	20 ANCHORAGE POINTE
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40223-2180
Country	:	US
Telephone Number	:	415-205-1229
Fax Number	:

Provider Business Practice Location Address
First Line	:	20 ANCHORAGE POINTE
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40223-2180
Country	:	US
Telephone Number	:	415-205-1229
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MARC ROTHMAN
Credential	:	MD
Telephone Number	:	415-205-1229

Provider Enumeration Date	:	04/30/2025
Last Update Date	:	04/30/2025

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