Provider Demographics
NPI:1841257888
Name:ROTH, RAYMOND D (DO)
Entity type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:D
Last Name:ROTH
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:511 E 3RD ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18015-2072
Mailing Address - Country:US
Mailing Address - Phone:484-526-4700
Mailing Address - Fax:484-526-2074
Practice Address - Street 1:511 E 3RD ST
Practice Address - Street 2:SUITE 200
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18015-2072
Practice Address - Country:US
Practice Address - Phone:484-526-4700
Practice Address - Fax:484-526-2074
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2016-08-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAOS005610L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001109294Medicaid
PA001109294Medicaid
D83803Medicare UPIN