MEDICARE: RICHARD L ROTH MD PC

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	0101028447	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	059999	OTHER	VA	ANTHEM BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	8555	OTHER	DC	CARE FIRST BCBS

General Provider Information

NPI Number	:	1740387976
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RICHARD L ROTH MD PC

Provider Business Mailing Address
First Line	:	6845 ELM STREET
Second Line	:	SUITE 210
City	:	MCLEAN
State	:	VA
Zip	:	22101-3822
Country	:	US
Telephone Number	:	703-821-2337
Fax Number	:

Provider Business Practice Location Address
First Line	:	6845 ELM STREET
Second Line	:	SUITE 210
City	:	MCLEAN
State	:	VA
Zip	:	22101-3822
Country	:	US
Telephone Number	:	703-821-2337
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	RICHARD LEE ROTH
Credential	:	MD
Telephone Number	:	703-821-2337

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	08/19/2008

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