MEDICARE: SHARI MADELENE ROTH M.D.

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	207W00000X	Ophthalmology Physician	032607	CT

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	:	1538135579
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHARI MADELENE ROTH M.D.

Provider Business Mailing Address
First Line	:	836 FARMINGTON AVE
Second Line	:	SUITE 121
City	:	WEST HARTFORD
State	:	CT
Zip	:	06119-1505
Country	:	US
Telephone Number	:	860-523-1900
Fax Number	:	860-236-3607

Provider Business Practice Location Address
First Line	:	836 FARMINGTON AVE
Second Line	:	SUITE 121
City	:	WEST HARTFORD
State	:	CT
Zip	:	06119-1505
Country	:	US
Telephone Number	:	860-523-1900
Fax Number	:	860-236-3607

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

Provider Enumeration Date	:	02/28/2006
Last Update Date	:	07/08/2007

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