Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207QG0300X | Family Doctor - Geriatric Medicine | MD013615E | PA |
Y | 207QG0300X | Family Doctor - Geriatric Medicine | ME118033 | FL |
NPI | 1194807206 |
---|---|
Provider Name | Dr. Maryelizabeth Anne Roth |
First Address | Boynton Beach, FL 33435-7501 |
Second Address | Boynton Beach, FL 33435-7501 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/10/2006 |
Last Update Date | 09/10/2015 |