Individual
KELLY ROTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
82 NEW PARK AVE, NORTH FRANKLIN, CT 06254-1807
(860) 889-7345
Mailing address
82 NEW PARK AVE, NORTH FRANKLIN, CT 06254-1807
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
—
—
Other
Enumeration date
09/08/2016
Last updated
09/08/2016
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