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NPI Code Detail

MEDICARE: CARL ROTH

MEDICARE: CARL ROTH
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
1207R00000XInternal Medicine Physician200012NY

General Provider Information

NPI Number : 1942303029
Entity Type Code : Individual
Provider Name (Legal Business Name) : CARL ROTH
Provider Business Mailing Address
First Line : 113 MAIN ST
Second Line :
City : SILVER CREEK
State : NY
Zip : 14136-1452
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 113 MAIN ST
Second Line :
City : SILVER CREEK
State : NY
Zip : 14136-1452
Country : US
Telephone Number : 716-934-4518
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/06/2006
Last Update Date : 01/25/2024

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Directions to “ CARL ROTH ” Practice Location

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