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General NPI Number Information
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NPI Number | 1346563285
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Entity Type | Organization
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Legal Business Name | MICHAEL S. ROATH MD FAPA PC
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Dates
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Enumeration Date | 03/06/2010
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Last Update Date | 03/06/2010
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Provider Practice Location Address
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Address Line | 8322 TRAFORD LN SUITE D
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City | SPRINGFIELD
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State | VA
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Zip | 22152-1668
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Country | US
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Telephone | 703-451-6113
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Fax | 703-866-2430
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Provider Business Mailing Address
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Address Line | 8322 TRAFORD LN SUITE D
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City | SPRINGFIELD
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State | VA
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Zip | 22152-1668
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Country | US
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Telephone | 703-451-6113
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Fax | 703-866-2430
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Authorized Official
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Title or Position | PHYSICIAN/PSYCHIATRIST
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Name | MICHAEL S. ROATH
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Credential | MD
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Telephone | 703-451-6113
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | 0101020922
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License Number State | VA
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