Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | 155168 | MA |
NPI | 1033163910 |
---|---|
Provider Name | Jason S Rothman |
First Address | Boston, MA 02114-2517 |
Second Address | Boston, MA 02114-2517 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2006 |
Last Update Date | 17/12/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
110038800A | (05) | MA |
2076748 | (05) | MA |
H66866 | (02) | MA |