Healthcare Provider Details

I. General information

NPI: 1952216756
Provider Name (Legal Business Name): HEIDI ROTH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

269 APPLETON ST
ARLINGTON MA
02476-7155
US

IV. Provider business mailing address

269 APPLETON ST
ARLINGTON MA
02476-7155
US

V. Phone/Fax

Practice location:
  • Phone: 781-640-2955
  • Fax:
Mailing address:
  • Phone: 781-640-2955
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberLDN2949
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: