Provider Demographics
NPI:1194807206
Name:ROTH, MARYELIZABETH ANNE (MD)
Entity type:Individual
Prefix:DR
First Name:MARYELIZABETH
Middle Name:ANNE
Last Name:ROTH
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:2623 S SEACREST BLVD
Mailing Address - Street 2:SUTE 65
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33435-7501
Mailing Address - Country:US
Mailing Address - Phone:561-806-6835
Mailing Address - Fax:561-806-6607
Practice Address - Street 1:2623 S SEACREST BLVD
Practice Address - Street 2:SUITE 65
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33435-7501
Practice Address - Country:US
Practice Address - Phone:561-806-6835
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2015-10-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD013615E207QG0300X
FLME118033207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine