Individual
TODD STUART ROTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
9050 TRADD ST, BOCA RATON, FL 33434-5902
(804) 828-9783
Mailing address
9050 TRADD ST, BOCA RATON, FL 33434-5902
(804) 828-9783
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
0101245157
VA
208000000X
Pediatrics Physician
ME 112786
FL
2080P0202X
Pediatric Cardiology Physician
ME112786
FL
390200000X
Student in an Organized Health Care Education/Training Program
0116018547
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
C09463
GROUP PTAN
VA
Enumeration date
05/22/2007
Last updated
08/01/2012
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