Individual
MARA Y ROTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1959 NE PACIFIC ST, SEATTLE, WA 98195-0001
(206) 598-4615
Mailing address
PO BOX 50095, SEATTLE, WA 98145-5095
(206) 543-6420
Taxonomy
Speciality
Code
Description
License number
State
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
Primary
MD00045747
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
02637000
L&I
WA
05
—
1992997332
—
WA
Enumeration date
08/09/2007
Last updated
12/24/2012
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