Provider Demographics
NPI:1619214384
Name:ROTH, FRAN SUSAN (MD)
Entity Type:Individual
Prefix:DR
First Name:FRAN
Middle Name:SUSAN
Last Name:ROTH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:83 VERNON DR
Mailing Address - Street 2:
Mailing Address - City:SCARSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10583-6152
Mailing Address - Country:US
Mailing Address - Phone:914-462-1363
Mailing Address - Fax:
Practice Address - Street 1:83 VERNON DR
Practice Address - Street 2:
Practice Address - City:SCARSDALE
Practice Address - State:NY
Practice Address - Zip Code:10583-6152
Practice Address - Country:US
Practice Address - Phone:914-462-1363
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-14
Last Update Date:2013-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY139798174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist