Provider Demographics
NPI:1811922867
Name:ROTH, MELINDA-ANN B (MD)
Entity type:Individual
Prefix:DR
First Name:MELINDA-ANN
Middle Name:B
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 1:644 COCKEYS MILL RD
Mailing Address - Street 2:
Mailing Address - City:REISTERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21136-5116
Mailing Address - Country:US
Mailing Address - Phone:410-833-8205
Mailing Address - Fax:
Practice Address - Street 1:540 JERMOR LN STE A
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157-6490
Practice Address - Country:US
Practice Address - Phone:410-871-3025
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2024-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0037535208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD253003100Medicaid
MD253003100Medicaid
MD253003100Medicaid