Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | DS015496L | PA |
NPI | 1083671192 |
---|---|
Provider Name | Dr. Bernard Norman Rothman |
First Address | Philadelphia, PA 19103-6512 |
Second Address | Philadelphia, PA 19141-3038 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/05/2006 |
Last Update Date | 27/02/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
061742 | (02) | PA |