Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 35.099194 | OH |
Y | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | TP306 | KY |
NPI | 1164657730 |
---|---|
Provider Name | Lauren Roth |
First Address | Cincinnati, OH 45263-5283 |
Second Address | Edgewood, KY 41017-3403 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/05/2009 |
Last Update Date | 03/09/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0066214 | (05) | OH |