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NPI Code Detail

MEDICARE: RYAN ROTH PA

MEDICARE: RYAN ROTH PA
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
1363AM0700XMedical Physician Assistant50-00-2058OH

General Provider Information

NPI Number : 1487651436
Entity Type Code : Individual
Provider Name (Legal Business Name) : RYAN ROTH PA
Provider Business Mailing Address
First Line : 4235 SECOR ROAD
Second Line :
City : TOLEDO
State : OH
Zip : 43623
Country : US
Telephone Number : 419-473-3561
Fax Number :
Provider Business Practice Location Address
First Line : 4126 N HOLLAND SYLVANIA RD
Second Line : SUITE 120
City : TOLEDO
State : OH
Zip : 43623-3536
Country : US
Telephone Number : 419-479-5386
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/06/2005
Last Update Date : 11/03/2023

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Directions to “ RYAN ROTH PA” Practice Location

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