Provider Demographics
NPI:1063415289
Name:ROTHEN, ROBERTA LOUISE (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERTA
Middle Name:LOUISE
Last Name:ROTHEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:13 WESTERN MARYLAND PKWY
Mailing Address - Street 2:STE 104
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21740-6474
Mailing Address - Country:US
Mailing Address - Phone:301-665-4575
Mailing Address - Fax:301-665-4576
Practice Address - Street 1:13 WESTERN MARYLAND PARKWAY
Practice Address - Street 2:STE 104
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-5146
Practice Address - Country:US
Practice Address - Phone:301-665-4575
Practice Address - Fax:301-665-4576
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2015-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0040493207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD803903800Medicaid
H34202Medicare UPIN
322825YURCMedicare PIN
MD803903800Medicaid