Provider Demographics
NPI:1063417848
Name:ROTHSTEIN, MARK A (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:A
Last Name:ROTHSTEIN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:9 POINT WEST BLVD
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63301
Mailing Address - Country:US
Mailing Address - Phone:636-441-7900
Mailing Address - Fax:636-441-1980
Practice Address - Street 1:9 POINT WEST BLVD
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63301
Practice Address - Country:US
Practice Address - Phone:636-441-7900
Practice Address - Fax:636-441-1980
Is Sole Proprietor?:No
Enumeration Date:2005-06-17
Last Update Date:2018-05-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO101213207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOG09808Medicare UPIN