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Individual

MATT D ROTH

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
2865 N REYNOLDS RD STE 260, TOLEDO, OH 43615-2070
(419) 578-4280
(419) 537-5684
Mailing address
660 BEAVER CREEK CIR, SUITE 110, MAUMEE, OH 43537-1745
(419) 891-6210
(419) 893-3232

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
35088737
OH
207QS0010X
Sports Medicine (Family Medicine) Physician
35-088737
OH

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000571949
ANTHEM
01
05455
PARAMOUNT
05
2769839
OH
01
9202151
AETNA
01
PENDING
RRMC
Enumeration date
05/14/2007
Last updated
11/03/2023
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