MEDICARE: MEGAN ROTH

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
1	133V00000X	Registered Dietitian

General Provider Information

NPI Number	:	1639037518
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEGAN ROTH

Provider Business Mailing Address
First Line	:	1863 OXBOROUGH CT
Second Line	:
City	:	CHESTERFIELD
State	:	MO
Zip	:	63017-8037
Country	:	US
Telephone Number	:	615-720-0335
Fax Number	:

Provider Business Practice Location Address
First Line	:	1863 OXBOROUGH CT
Second Line	:
City	:	CHESTERFIELD
State	:	MO
Zip	:	63017-8037
Country	:	US
Telephone Number	:	615-720-0335
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/12/2026
Last Update Date	:	01/12/2026

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