Healthcare Provider Details

I. General information

NPI: 1629134580
Provider Name (Legal Business Name): MARY ELIZABETH WROTH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

606 DUTCHMANS LN
EASTON MD
21601-3346
US

IV. Provider business mailing address

606 DUTCHMANS LN
EASTON MD
21601-3346
US

V. Phone/Fax

Practice location:
  • Phone: 410-763-8272
  • Fax: 410-763-6014
Mailing address:
  • Phone: 410-763-8272
  • Fax: 410-763-6014

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD0059767
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: