Provider Demographics
NPI:1811055189
Name:ROTH, DANIEL J (MD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:J
Last Name:ROTH
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:4600 MCAULEY PL
Mailing Address - Street 2:SUITE 115
Mailing Address - City:BLUE ASH
Mailing Address - State:OH
Mailing Address - Zip Code:45242-4733
Mailing Address - Country:US
Mailing Address - Phone:513-981-4646
Mailing Address - Fax:513-981-4647
Practice Address - Street 1:4600 MCAULEY PL
Practice Address - Street 2:SUITE 115
Practice Address - City:BLUE ASH
Practice Address - State:OH
Practice Address - Zip Code:45242-4733
Practice Address - Country:US
Practice Address - Phone:513-981-4646
Practice Address - Fax:513-981-4647
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2013-01-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OH35076322207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2138225Medicaid
OH0884814Medicare PIN
G99748Medicare UPIN