MEDICARE: DR. BARBARA A ROTH MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	A86447	CA
2	2084P0800X	Psychiatry Physician	55442	MN
3	2084P0800X	Psychiatry Physician	23827	NE

General Provider Information

NPI Number	:	1164533741
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BARBARA A ROTH MD

Provider Business Mailing Address
First Line	:	PO BOX 860876
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55486-0876
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2221 S 17TH ST STE 310
Second Line	:
City	:	LINCOLN
State	:	NE
Zip	:	68502-3700
Country	:	US
Telephone Number	:	402-483-8555
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	07/11/2025

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