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NPI Code Detail

MEDICARE: DR. ROBERT ERIC ROTH PSYD

MEDICARE: DR. ROBERT ERIC ROTH PSYD
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
1103T00000XPsychologist2177TN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
14076590OTHERTNBCBS - MEDICAL
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
34037912OTHERTNBCBS - BEHAVIORAL HEALTH
4TN0101OTHERTNJOHN DEERE

General Provider Information

NPI Number : 1992792519
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ROBERT ERIC ROTH PSYD
Provider Business Mailing Address
First Line : 2333 KNOB CREEK RD
Second Line : SUITE 11
City : JOHNSON CITY
State : TN
Zip : 37604-2007
Country : US
Telephone Number : 423-952-0500
Fax Number : 423-952-0005
Provider Business Practice Location Address
First Line : 2333 KNOB CREEK RD
Second Line : SUITE 11
City : JOHNSON CITY
State : TN
Zip : 37604-2007
Country : US
Telephone Number : 423-952-0500
Fax Number : 423-952-0005
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/29/2005
Last Update Date : 07/08/2007

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Directions to “ DR. ROBERT ERIC ROTH PSYD” Practice Location

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