Provider Demographics
NPI:1265668271
Name:STEVEN M. ROTH, M.D., P.C.
Entity Type:Organization
Organization Name:STEVEN M. ROTH, M.D., P.C.
Other - Org Name:AUGUSTA VASCULAR SURGICAL AND VEIN CARE ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:ROTH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-736-8777
Mailing Address - Street 1:2101 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30904-6706
Mailing Address - Country:US
Mailing Address - Phone:706-736-8777
Mailing Address - Fax:706-738-2888
Practice Address - Street 1:2101 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30904-6706
Practice Address - Country:US
Practice Address - Phone:706-736-8777
Practice Address - Fax:706-738-2888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-04
Last Update Date:2009-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA77BBBMLMedicare PIN
GAH17626Medicare UPIN