Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | MD059781L | PA |
NPI | 1346240322 |
---|---|
Provider Name | Dr. Philip Lee Rothbart |
First Address | Kennett Square, PA 19348-2716 |
Second Address | Kennett Square, PA 19348-2716 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/07/2005 |
Last Update Date | 07/12/2015 |