Provider Demographics
NPI:1356929681
Name:ROTH, KAYLI ANN (DO)
Entity type:Individual
Prefix:DR
First Name:KAYLI
Middle Name:ANN
Last Name:ROTH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8955 WOOD RD
Mailing Address - Street 2:BUILDING 1, 19TH FLOOR
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20889-5628
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8955 WOOD RD
Practice Address - Street 2:BUILDING 1, 19TH FLOOR
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20889-5628
Practice Address - Country:US
Practice Address - Phone:301-295-0537
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-30
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102207388208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice