Individual
DR. ROBERT MARK ROTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
1 MEDICAL CENTER DRIVE, LEBANON, NH 03756-0001
(603) 650-7232
(603) 650-9478
Mailing address
1 MEDICAL CENTER DRIVE, LEBANON, NH 03756-0001
(603) 650-7232
(603) 650-9478
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
974
NH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1008316
MEDICAID
VT
05
—
30421662
—
NH
Enumeration date
12/04/2006
Last updated
07/08/2007
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