Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | 01451 | MD |
NPI | 1467562389 |
---|---|
Provider Name | Dr. Mark William Rothstein |
First Address | Baltimore, MD 21209-3303 |
Second Address | Baltimore, MD 21209-3303 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2006 |
Last Update Date | 01/06/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
423468 | (05) | AZ |
AZ0194730 | BCBS (01) | AZ |
U86360 | (02) | AZ |