Individual
LAURA BLAKE ROTH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
212 CREEK CROSSING BLVD., HAINESPORT, NJ 08036
(856) 206-4795
Mailing address
301 LIPPINCOTT DR STE 410, MARLTON, NJ 08053-4197
(856) 247-7210
(856) 247-7511
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
25MP00817500
NJ
363AM0700X
Medical Physician Assistant
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Other
Enumeration date
08/23/2021
Last updated
11/27/2024
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