Individual
SUSAN B ROTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
3400 SPRUCE ST, GROUND FLOOR DULLES, PHILADELPHIA, PA 19104
(215) 662-3005
(215) 662-7011
Mailing address
3400 SPRUCE ST, PHILADELPHIA, PA 19104
(215) 662-3005
(215) 662-7011
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
C1-0013061
DE
2085R0202X
Diagnostic Radiology Physician
Primary
MD045361E
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0012252390001
—
PA
Enumeration date
06/25/2006
Last updated
07/05/2019
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