Individual
JEREMY BONN ROTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
7490 NEW TECHNOLOGY WAY, FREDERICK, MD 21703-8370
(240) 566-1600
Mailing address
913 HILLSTEAD DR, LUTHERVILLE, MD 21093-4748
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
D50052
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
601285800
FECA
—
05
—
834910000
—
MD
Enumeration date
06/02/2006
Last updated
08/13/2013
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