Provider Demographics
NPI:1760586333
Name:ROTH, HARVEY C (MD)
Entity Type:Individual
Prefix:DR
First Name:HARVEY
Middle Name:C
Last Name:ROTH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:20423 STATE ROAD 7
Mailing Address - Street 2:F6-199
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33498-6797
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:561-883-0042
Practice Address - Street 1:20423 STATE ROAD 7
Practice Address - Street 2:F6-199
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33498-6797
Practice Address - Country:US
Practice Address - Phone:954-733-0121
Practice Address - Fax:954-733-3870
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2015-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME3446374207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL253585800Medicaid