Provider Demographics
NPI:1346382868
Name:ROTH, BARRY HOWARD (MD)
Entity type:Individual
Prefix:DR
First Name:BARRY
Middle Name:HOWARD
Last Name:ROTH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 432
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:NH
Mailing Address - Zip Code:03584-0432
Mailing Address - Country:US
Mailing Address - Phone:603-788-2521
Mailing Address - Fax:
Practice Address - Street 1:320 WASHINGTON ST
Practice Address - Street 2:SUITE 4
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02445-6873
Practice Address - Country:US
Practice Address - Phone:603-788-2521
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA386702084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1019885Medicaid
NHCO479301OtherMEDICARE PTAN
MAC04793OtherBLUE CROSS BLUE SHIELD OF
MA0163724Medicaid
MA715332OtherTUFTS
NH30003937Medicaid
MAC04793OtherBLUE CROSS BLUE SHIELD OF
MAC04793Medicare ID - Type Unspecified