Provider Demographics
NPI:1972539872
Name:ROTH, ANDREW M (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:M
Last Name:ROTH
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:8250 KENWOOD CROSSING WAY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45236-3668
Mailing Address - Country:US
Mailing Address - Phone:513-221-5500
Mailing Address - Fax:513-221-1962
Practice Address - Street 1:8250 KENWOOD CROSSING WAY
Practice Address - Street 2:SUITE 100
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45236-3668
Practice Address - Country:US
Practice Address - Phone:513-221-5500
Practice Address - Fax:513-221-1962
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2012-04-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OH35039446 R207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0686315Medicaid
KY64780075Medicaid
KY64780075Medicaid