Provider Demographics
NPI:1033437819
Name:ROTH, KAMELA L (PAC)
Entity Type:Individual
Prefix:MRS
First Name:KAMELA
Middle Name:L
Last Name:ROTH
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:MRS
Other - First Name:KAMELA
Other - Middle Name:L
Other - Last Name:KING
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PAC
Mailing Address - Street 1:PO BOX 22581
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10087-2581
Mailing Address - Country:US
Mailing Address - Phone:610-482-4795
Mailing Address - Fax:856-528-3117
Practice Address - Street 1:599 W STATE ST
Practice Address - Street 2:SUITE 301
Practice Address - City:DOYLESTOWN
Practice Address - State:PA
Practice Address - Zip Code:18901-2567
Practice Address - Country:US
Practice Address - Phone:215-489-2066
Practice Address - Fax:215-489-1166
Is Sole Proprietor?:No
Enumeration Date:2010-05-04
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOA000243L363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical