Healthcare Provider Details

I. General information

NPI: 1992569503
Provider Name (Legal Business Name): EMILY ROTH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2024
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 TATE SPRINGS RD
LYNCHBURG VA
24501-1167
US

IV. Provider business mailing address

251 MOZART LN APT 5406
LYNCHBURG VA
24502-1292
US

V. Phone/Fax

Practice location:
  • Phone: 434-200-3027
  • Fax:
Mailing address:
  • Phone: 602-545-2699
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: