Provider Demographics
NPI:1205862448
Name:ROTH, DAVID A (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:A
Last Name:ROTH
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Gender:M
Credentials:MD
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Mailing Address - Street 1:3 WOODLAND RD
Mailing Address - Street 2:STE 412
Mailing Address - City:STONEHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02180-1714
Mailing Address - Country:US
Mailing Address - Phone:781-665-3355
Mailing Address - Fax:781-662-9675
Practice Address - Street 1:3 WOODLAND RD
Practice Address - Street 2:STE 412
Practice Address - City:STONEHAM
Practice Address - State:MA
Practice Address - Zip Code:02180-1714
Practice Address - Country:US
Practice Address - Phone:781-665-3355
Practice Address - Fax:781-662-9675
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-22
Last Update Date:2024-02-17
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Provider Licenses
StateLicense IDTaxonomies
MA25889207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
M05104Medicare ID - Type Unspecified
B98557Medicare UPIN