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Provider Information for 1154348043

Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know

DR. ALEXANDER ROTENBERG MD

Gender: MALE

Individual NPI: 1154348043

Calendar   Last Updated:  2007-08-24
  Certification Date: 

Details

Name Value
NPI 1154348043
Enumeration Date 2006-07-16
NPI Type 1 - Individual
Sole Proprietor NO
Status Active
Mailing Address 300 LONGWOOD AVE FEGAN 9
BOSTON, MA 02115-5724
United States

Phone: 617-355-7970 | Fax: 617-730-0463
View Map External Link
Primary Practice Address 300 LONGWOOD AVE FEGAN 9
BOSTON, MA 02115-5724
United States

Phone: 617-355-7970 | Fax: 617-730-0463
View Map External Link
Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
MEDICAID MA 2117274
Taxonomy
Primary Taxonomy Selected Taxonomy State License Number
Yes 2084N0402X - Psychiatry & Neurology Neurology with Special Qualifications in Child Neurology MA 224639
No 2084N0600X - Psychiatry & Neurology Clinical Neurophysiology MA 224639