Healthcare Provider Details

I. General information

NPI: 1760586333
Provider Name (Legal Business Name): HARVEY C ROTH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2006
Last Update Date: 04/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20423 STATE ROAD 7 F6-199
BOCA RATON FL
33498-6797
US

IV. Provider business mailing address

20423 STATE ROAD 7 F6-199
BOCA RATON FL
33498-6797
US

V. Phone/Fax

Practice location:
  • Phone: 954-733-0121
  • Fax: 954-733-3870
Mailing address:
  • Phone:
  • Fax: 561-883-0042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberME3446374
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: