Provider Demographics
NPI:1316044845
Name:ROTH, BETH ROBINS (APRN)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:ROBINS
Last Name:ROTH
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 185301
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06518-0301
Mailing Address - Country:US
Mailing Address - Phone:203-824-1249
Mailing Address - Fax:
Practice Address - Street 1:130 MONTOWESE ST STE 5
Practice Address - Street 2:
Practice Address - City:BRANFORD
Practice Address - State:CT
Practice Address - Zip Code:06405-3841
Practice Address - Country:US
Practice Address - Phone:203-824-1249
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-19
Last Update Date:2023-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000440363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008009705Medicaid
CT008009705Medicaid
CT041500091Medicare ID - Type Unspecified