Provider Demographics
NPI:1619127313
Name:ABINGTON MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:ABINGTON MEMORIAL HOSPITAL
Other - Org Name:JERRY M. ROTH M.D. F.A.C.P.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF OF STAFF
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:J
Authorized Official - Last Name:KELLY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:215-481-2000
Mailing Address - Street 1:501 STREET RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SOUTHAMPTON
Mailing Address - State:PA
Mailing Address - Zip Code:18966-3746
Mailing Address - Country:US
Mailing Address - Phone:215-357-5780
Mailing Address - Fax:215-364-8983
Practice Address - Street 1:501 STREET RD
Practice Address - Street 2:SUITE 101
Practice Address - City:SOUTHAMPTON
Practice Address - State:PA
Practice Address - Zip Code:18966-3746
Practice Address - Country:US
Practice Address - Phone:215-357-5780
Practice Address - Fax:215-364-8983
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ABINGTON MEMORIAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-09-30
Last Update Date:2008-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty