Provider Demographics
NPI:1700827268
Name:ROTH, SAMUEL KLEIN (PA)
Entity Type:Individual
Prefix:MR
First Name:SAMUEL
Middle Name:KLEIN
Last Name:ROTH
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:105 SW CARY PKWY
Mailing Address - Street 2:SUITE 300
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27511-5600
Mailing Address - Country:US
Mailing Address - Phone:919-467-3203
Mailing Address - Fax:919-459-5401
Practice Address - Street 1:105 SW CARY PKWY
Practice Address - Street 2:SUITE 300
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-5600
Practice Address - Country:US
Practice Address - Phone:919-467-3203
Practice Address - Fax:919-459-5401
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2010-10-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC101361363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCR34510Medicare UPIN
NC2744519KMedicare PIN