Provider Demographics
NPI:1568828259
Name:ROTH, NORMAN (MS, MD)
Entity Type:Individual
Prefix:
First Name:NORMAN
Middle Name:
Last Name:ROTH
Suffix:
Gender:M
Credentials:MS, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1062 BARNES RD
Mailing Address - Street 2:STE 300
Mailing Address - City:WALLINGFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06492-2576
Mailing Address - Country:US
Mailing Address - Phone:203-265-9831
Mailing Address - Fax:
Practice Address - Street 1:1062 BARNES RD STE 300
Practice Address - Street 2:
Practice Address - City:WALLINGFORD
Practice Address - State:CT
Practice Address - Zip Code:06492-2576
Practice Address - Country:US
Practice Address - Phone:605-251-5328
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-11
Last Update Date:2020-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT63322207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease