Provider Demographics
NPI:1841211745
Name:ROTH, LORRAINE SHARON (MD)
Entity Type:Individual
Prefix:DR
First Name:LORRAINE
Middle Name:SHARON
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 1:6178 EDSALL RD
Mailing Address - Street 2:APT. #96
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22304-5809
Mailing Address - Country:US
Mailing Address - Phone:571-970-2406
Mailing Address - Fax:
Practice Address - Street 1:6178 EDSALL RD
Practice Address - Street 2:APT. #96
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22304-5881
Practice Address - Country:US
Practice Address - Phone:571-970-2406
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-23
Last Update Date:2011-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC246142084F0202X, 2084P0800X
IL036-0795082084F0202X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084F0202XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyForensic Psychiatry