MEDICARE: SUSAN ROTH WILTON 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	MD054357L	PA

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
2	5914840001	OTHER	PA	PTAN

General Provider Information

NPI Number	:	1851370407
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN ROTH WILTON M.D.

Provider Business Mailing Address
First Line	:	51 NORTH 39TH STREET
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19104-2689
Country	:	US
Telephone Number	:	610-902-2020
Fax Number	:	610-902-1604

Provider Business Practice Location Address
First Line	:	145 KING OF PRUSSIA ROAD
Second Line	:	SUITE 204
City	:	RADNOR
State	:	PA
Zip	:	19087-4557
Country	:	US
Telephone Number	:	610-902-2020
Fax Number	:	610-902-1604

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

Provider Enumeration Date	:	01/12/2006
Last Update Date	:	11/10/2025

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Directions to “ SUSAN ROTH WILTON M.D.” Practice Location

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