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General NPI Number Information
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NPI Number | 1083363931
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Entity Type | Individual
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Provider Name | WARREN JOSEPH ROTH MD
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Gender | Male
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Dates
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Enumeration Date | 03/19/2022
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Last Update Date | 05/06/2024
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Provider Practice Location Address
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Address Line | 96 JONATHAN LUCAS ST # CS708
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City | CHARLESTON
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State | SC
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Zip | 29425-0100
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Country | US
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Telephone | 843-243-7278
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Fax |
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Provider Business Mailing Address
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Address Line | 96 JONATHAN LUCAS ST # 708
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City | CHARLESTON
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State | SC
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Zip | 29425-8900
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Country | US
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Telephone | 843-243-7278
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | LL90232
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License Number State | SC
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