Provider Demographics
NPI:1336233006
Name:ROTMAN, ERNEST KENNETH (PA-C,MPAS)
Entity type:Individual
Prefix:MR
First Name:ERNEST
Middle Name:KENNETH
Last Name:ROTMAN
Suffix:
Gender:M
Credentials:PA-C,MPAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 SANDY RIDGE CIR.
Mailing Address - Street 2:
Mailing Address - City:SHARON
Mailing Address - State:MA
Mailing Address - Zip Code:02067
Mailing Address - Country:US
Mailing Address - Phone:781-784-3499
Mailing Address - Fax:
Practice Address - Street 1:940 BELMONT STREET
Practice Address - Street 2:BVAMC
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301
Practice Address - Country:US
Practice Address - Phone:508-583-4500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1020363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant