Provider Demographics
NPI:1821289489
Name:ROTH, ROBERT M (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:M
Last Name:ROTH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Mailing Address - Street 1:16 CROWN HILL RD
Mailing Address - Street 2:
Mailing Address - City:ATKINSON
Mailing Address - State:NH
Mailing Address - Zip Code:03811-2213
Mailing Address - Country:US
Mailing Address - Phone:617-273-2916
Mailing Address - Fax:
Practice Address - Street 1:275 GROVE ST STE 1-110
Practice Address - Street 2:MCKESSON HEALTH SOLUTIONS
Practice Address - City:AUBURNDALE
Practice Address - State:MA
Practice Address - Zip Code:02466-2275
Practice Address - Country:US
Practice Address - Phone:617-273-2916
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-07
Last Update Date:2007-08-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA50798207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease