Individual
DOUGLAS A ROTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
90 S BEDFORD RD, MOUNT KISCO MEDICAL GROUP, PC, MOUNT KISCO, NY 10549-3412
(914) 241-1050
(914) 242-2909
Mailing address
110 S BEDFORD RD, MOUNT KISCO MEDICAL GROUP, PC, MOUNT KISCO, NY 10549-3446
(914) 241-1050
(914) 242-2909
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
Primary
186557
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01921351
—
NY
Enumeration date
06/01/2006
Last updated
07/22/2016
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