MEDICARE: MS. VIRGINIA T ROTH P.A.

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	363AM0700X	Medical Physician Assistant	MA001834L	PA

General Provider Information

NPI Number	:	1508832247
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. VIRGINIA T ROTH P.A.

Provider Business Mailing Address
First Line	:	100 N ACADEMY AVE
Second Line	:
City	:	DANVILLE
State	:	PA
Zip	:	17822-4093
Country	:	US
Telephone Number	:	570-271-6144
Fax Number	:	570-271-6578

Provider Business Practice Location Address
First Line	:	4230 CRUMS MILL RD
Second Line	:
City	:	HARRISBURG
State	:	PA
Zip	:	17112-2898
Country	:	US
Telephone Number	:	717-233-6171
Fax Number	:	717-233-7880

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

Provider Enumeration Date	:	02/23/2006
Last Update Date	:	07/30/2020

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