MEDICARE: SCOTT L. ROTH M.D, LLC

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	261QM2500X	Medical Specialty Clinic/Center	150586	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1447445291
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SCOTT L. ROTH M.D, LLC

Provider Business Mailing Address
First Line	:	1012 ELMGROVE RD
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14624-1324
Country	:	US
Telephone Number	:	585-426-4160
Fax Number	:	585-426-4167

Provider Business Practice Location Address
First Line	:	1012 ELMGROVE RD
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14624-1324
Country	:	US
Telephone Number	:	585-426-4160
Fax Number	:	585-426-4167

Authorized Official
Title or Position	:	OWNER
Name	:	DR. SCOTT LEONARD ROTH
Credential	:	M.D.
Telephone Number	:	585-426-4160

Provider Enumeration Date	:	09/13/2007
Last Update Date	:	09/13/2007

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