Provider Demographics
NPI:1790730208
Name:WRAY ROTH, DOREEN L (MD)
Entity Type:Individual
Prefix:
First Name:DOREEN
Middle Name:L
Last Name:WRAY ROTH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DOREEN
Other - Middle Name:L
Other - Last Name:WRAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:110 S BEDFORD RD
Mailing Address - Street 2:THE AMBULATORY SURGERY CENTER OF WESTCHESTER
Mailing Address - City:MT. KISCO
Mailing Address - State:NY
Mailing Address - Zip Code:10549
Mailing Address - Country:US
Mailing Address - Phone:914-244-6789
Mailing Address - Fax:914-242-1516
Practice Address - Street 1:34 S BEDFORD RD
Practice Address - Street 2:THE AMBULATORY SURGERY CENTER OF WESTCHESTER
Practice Address - City:MT. KISCO
Practice Address - State:NY
Practice Address - Zip Code:10549
Practice Address - Country:US
Practice Address - Phone:914-244-6789
Practice Address - Fax:914-242-1516
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY172852207L00000X, 207LP3000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Not Answered207LP3000XAllopathic & Osteopathic PhysiciansAnesthesiologyPediatric Anesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYE62420Medicare UPIN
NY62F461Medicare ID - Type Unspecified