Provider Demographics
NPI:1528083599
Name:ROTMAN, BARRY L (MD)
Entity type:Individual
Prefix:DR
First Name:BARRY
Middle Name:L
Last Name:ROTMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1535 TREAT BLVD
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-1043
Mailing Address - Country:US
Mailing Address - Phone:925-296-9228
Mailing Address - Fax:925-296-9227
Practice Address - Street 1:1535 TREAT BLVD
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-1043
Practice Address - Country:US
Practice Address - Phone:925-296-9228
Practice Address - Fax:925-296-9227
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2016-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG72260207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G72260Medicaid
CA00G72260Medicaid
CA00G72260Medicare PIN