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NPI Code Detail

MEDICARE: DOUGLAS M ROTH DO

MEDICARE: DOUGLAS M ROTH DO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207R00000XInternal Medicine PhysicianMB53578NJ

General Provider Information

NPI Number : 1346212057
Entity Type Code : Individual
Provider Name (Legal Business Name) : DOUGLAS M ROTH DO
Provider Business Mailing Address
First Line : 1 DIAMOND HILL RD
Second Line : SUMMIT MEDICAL GROUP
City : BERKELEY HEIGHTS
State : NJ
Zip : 07922-2104
Country : US
Telephone Number : 908-273-4300
Fax Number : 973-376-0357
Provider Business Practice Location Address
First Line : 85 WOODLAND RD
Second Line : SUMMIT MEDICAL GROUP
City : SHORT HILLS
State : NJ
Zip : 07078-2449
Country : US
Telephone Number : 973-315-9076
Fax Number : 973-376-0357
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/06/2006
Last Update Date : 07/09/2019

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