Basic Information
| Provider Information | |||||||||
| NPI: | 1033107495 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ROTHMAN | ||||||||
| FirstName: | MARK | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 150 BLUFF AVE | ||||||||
| Address2: | |||||||||
| City: | NORTH AUGUSTA | ||||||||
| State: | SC | ||||||||
| PostalCode: | 298413862 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8003944445 | ||||||||
| FaxNumber: | 7063963252 | ||||||||
| Practice Location | |||||||||
| Address1: | 120 S SPALDING DR | ||||||||
| Address2: | STE. 301 | ||||||||
| City: | BEVERLY HILLS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902121800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3103857755 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/11/2005 | ||||||||
| LastUpdateDate: | 06/08/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | G83051 | CA | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.