Healthcare Provider Details

I. General information

NPI: 1295295772
Provider Name (Legal Business Name): DANIELLE MARIE ROTH AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2019
Last Update Date: 03/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2851 BAGLYOS CIR STE 201
BETHLEHEM PA
18020-8038
US

IV. Provider business mailing address

3445 HIGH POINT BLVD STE 400
BETHLEHEM PA
18017-7817
US

V. Phone/Fax

Practice location:
  • Phone: 610-867-7134
  • Fax:
Mailing address:
  • Phone: 610-866-5555
  • Fax: 610-866-3151

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: