Provider Demographics
NPI:1306896527
Name:ROFMAN, ETHAN SAMUEL (MD)
Entity type:Individual
Prefix:DR
First Name:ETHAN
Middle Name:SAMUEL
Last Name:ROFMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 GRANT AVE
Mailing Address - Street 2:
Mailing Address - City:NEWTON CENTRE
Mailing Address - State:MA
Mailing Address - Zip Code:02459-1350
Mailing Address - Country:US
Mailing Address - Phone:781-687-2405
Mailing Address - Fax:781-687-2428
Practice Address - Street 1:123 GRANT AVE
Practice Address - Street 2:
Practice Address - City:NEWTON CENTRE
Practice Address - State:MA
Practice Address - Zip Code:02459-1350
Practice Address - Country:US
Practice Address - Phone:781-687-2405
Practice Address - Fax:781-687-2428
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA296782084P0802X, 2084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Psychiatry
Not Answered2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAB95173Medicare UPIN