Provider Demographics
NPI:1457550428
Name:ROTH, ADAM M (MD)
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:M
Last Name:ROTH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1410 FOREST DR
Mailing Address - Street 2:SUITE 24
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21403-1472
Mailing Address - Country:US
Mailing Address - Phone:410-626-1088
Mailing Address - Fax:410-626-0780
Practice Address - Street 1:1410 FOREST DR
Practice Address - Street 2:SUITE 24
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21403-1472
Practice Address - Country:US
Practice Address - Phone:410-626-1088
Practice Address - Fax:410-626-0780
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-11
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD410032084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry