MEDICARE: DR. MARK DAVID ROTHMAN M.D.

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	174400000X	Specialist	31375	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	73447	OTHER	NY	BCBS PROVIDER NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1891774840
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK DAVID ROTHMAN M.D.

Provider Business Mailing Address
First Line	:	3604 BUSH ST
Second Line	:	2ND FLOOR
City	:	RALEIGH
State	:	NC
Zip	:	27609-7511
Country	:	US
Telephone Number	:	919-876-7807
Fax Number	:	919-876-8823

Provider Business Practice Location Address
First Line	:	3604 BUSH ST
Second Line	:	2ND FLOOR
City	:	RALEIGH
State	:	NC
Zip	:	27609-7511
Country	:	US
Telephone Number	:	919-876-7807
Fax Number	:	919-876-8823

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

Provider Enumeration Date	:	01/10/2006
Last Update Date	:	03/24/2011

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