Healthcare Provider Details

I. General information

NPI: 1841257888
Provider Name (Legal Business Name): RAYMOND D. ROTH D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 08/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

511 E 3RD ST SUITE 200
BETHLEHEM PA
18015-2072
US

IV. Provider business mailing address

511 E 3RD ST SUITE 200
BETHLEHEM PA
18015-2072
US

V. Phone/Fax

Practice location:
  • Phone: 484-526-4700
  • Fax: 484-526-2074
Mailing address:
  • Phone: 484-526-4700
  • Fax: 484-526-2074

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS005610L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: