Provider Demographics
NPI:1518964758
Name:ROTH, DONNA E (MD)
Entity Type:Individual
Prefix:DR
First Name:DONNA
Middle Name:E
Last Name:ROTH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3475 RICHMOND RD
Mailing Address - Street 2:STE 200
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-2500
Mailing Address - Country:US
Mailing Address - Phone:859-296-4400
Mailing Address - Fax:859-296-4300
Practice Address - Street 1:3475 RICHMOND RD
Practice Address - Street 2:STE 200
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-2500
Practice Address - Country:US
Practice Address - Phone:859-296-4400
Practice Address - Fax:859-296-4300
Is Sole Proprietor?:No
Enumeration Date:2005-07-01
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY25432207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY0007542016OtherAETNA PROVIDER NUMBER
KY000000007043OtherCHA PROVIDER NUMBER
KY000000317657OtherANTHEM PROVIDER NUMBER
KY000000007043OtherCHA PROVIDER NUMBER