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Individual

DR. BARRY HOWARD ROTH

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
320 WASHINGTON ST, SUITE 4, BROOKLINE, MA 02445-6873
(603) 788-2521
Mailing address
PO BOX 432, LANCASTER, NH 03584-0432
(603) 788-2521

Taxonomy

Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
38670
MA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0163724
MA
05
1019885
VT
05
30003937
NH
01
715332
TUFTS
MA
01
C04793
BLUE CROSS BLUE SHIELD OF
MA
01
CO479301
MEDICARE PTAN
NH
Enumeration date
02/12/2007
Last updated
06/12/2012
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