Healthcare Provider Details

I. General information

NPI: 1285724567
Provider Name (Legal Business Name): BARBARA KAY ROTH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/15/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 SENECA AVE
BYESVILLE OH
43723-1335
US

IV. Provider business mailing address

205 SENECA AVE
BYESVILLE OH
43723-1335
US

V. Phone/Fax

Practice location:
  • Phone: 740-685-2011
  • Fax: 740-685-8785
Mailing address:
  • Phone: 740-685-2011
  • Fax: 740-685-8785

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35059216
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: