Healthcare Provider Details

I. General information

NPI: 1609452168
Provider Name (Legal Business Name): MAXWELL TAYLOR ROTH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2021
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 BROOKLINE AVE BETH ISRAEL DEACONESS MEDICAL CENTER DEPT OF PATHOLOGY
BOSTON MA
02215-5400
US

IV. Provider business mailing address

330 BROOKLINE AVE BETH ISRAEL DEACONESS MEDICAL CENTER DEPT OF PATHOLOGY
BOSTON MA
02215-5400
US

V. Phone/Fax

Practice location:
  • Phone: 617-667-7000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number1021580
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: