Healthcare Provider Details

I. General information

NPI: 1821013236
Provider Name (Legal Business Name): MICHELLE AYOLA ROETT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 10/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4151 BLADENSBURG RD
COLMAR MANOR MD
20722-1928
US

IV. Provider business mailing address

1150 VARNUM ST NE
WASHINGTON DC
20017
US

V. Phone/Fax

Practice location:
  • Phone: 301-699-7700
  • Fax: 301-779-9001
Mailing address:
  • Phone: 202-269-7000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD035386
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: