Healthcare Provider Details

I. General information

NPI: 1649117953
Provider Name (Legal Business Name): HARI ROTH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3401 N BROAD ST
PHILA PA
19140-5189
US

IV. Provider business mailing address

3401 N BROAD ST
PHILA PA
19140-5189
US

V. Phone/Fax

Practice location:
  • Phone: 215-707-2000
  • Fax:
Mailing address:
  • Phone: 215-707-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMT236563
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: