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General NPI Number Information
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NPI Number | 1508897380
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Entity Type | Individual
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Provider Name | DAVID LAWRENCE ROTH MD
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Gender | Male
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Dates
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Enumeration Date | 07/06/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 13951 TERRACE RD
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City | CLEVELAND
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State | OH
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Zip | 44112-4308
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Country | US
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Telephone | 216-761-3300
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Fax |
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Provider Business Mailing Address
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Address Line | 4560 LANDER RD
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City | CHAGRIN FALLS
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State | OH
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Zip | 44022-1702
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Country | US
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Telephone | 440-498-1699
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 78662
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License Number State | OH
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