Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208100000X | Physical Medicine & Rehabilitation Doctor | C2-0013778 | DE |
Y | 2081P2900X | Pain Medicine | C2-0013778 | DE |
NPI | 1134514706 |
---|---|
Provider Name | Jason Roth |
First Address | Chadds Ford, PA 19317-9007 |
Second Address | Middletown, DE 19709-5859 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/04/2015 |
Last Update Date | 04/08/2021 |