Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 0101245157 | VA |
N | 208000000X | Pediatrician | ME 112786 | FL |
N | 2080P0202X | Pediatric Cardiologist | ME112786 | FL |
NPI | 1063622090 |
---|---|
Provider Name | Todd Stuart Roth |
First Address | Boca Raton, FL 33434-5902 |
Second Address | Boca Raton, FL 33434-5902 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2007 |
Last Update Date | 01/08/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C09463 | GROUP PTAN (01) | VA |