Provider Demographics
NPI:1124348693
Name:ROSZKO, KELLY BETH LAUTER (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:KELLY
Middle Name:BETH LAUTER
Last Name:ROSZKO
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:DR
Other - First Name:KELLY
Other - Middle Name:BETH
Other - Last Name:LAUTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD, PHD
Mailing Address - Street 1:30 CONVENT DR BUILDING 30
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20892-0001
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:30 CONVENT DR BUILDING 30
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20892
Practice Address - Country:US
Practice Address - Phone:617-726-2865
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-08
Last Update Date:2018-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA253731207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism