1427055953 NPI number — MONIQUE E ROTH MD

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427055953 NPI number — MONIQUE E ROTH MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROTH
Provider First Name:
MONIQUE
Provider Middle Name:
E
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1427055953
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/10/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 9120
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DEDHAM
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02027-9120
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
781-329-1400
Provider Business Mailing Address Fax Number:
781-278-5667

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 LYONS ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DEDHAM
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02026-5599
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
781-329-1400
Provider Business Practice Location Address Fax Number:
781-278-5667
Provider Enumeration Date:
06/30/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207N00000X , with the licence number:  75907 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0300320 . This is a "UNITED HEALTHCARE(HMO/PPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 075907 . This is a "TUFTS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2733572 . This is a "HEALTHSOURCE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 0014523 . This is a "NEIGHBORHOOD HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 401095 . This is a "HARVARD PILGRIM PPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 070013072 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2733572 . This is a "CIGNA HEALTH CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 27684 . This is a "CHILDREN'S MED. SECURITY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3193B70 . This is a "MASS.HEALTH(DIV.MEDSVCS)" identifier . This identifiers is of the category "OTHER".
  • Identifier: 401095 . This is a "HARVARD PILGRIM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 401095 . This is a "HARVARD PILGRIM POS" identifier . This identifiers is of the category "OTHER".
  • Identifier: J16188 . This is a "BLUE SHIELD INDEMNITY" identifier . This identifiers is of the category "OTHER".
  • Identifier: J16188 . This is a "BS-BLUE CARE ELECT" identifier . This identifiers is of the category "OTHER".
  • Identifier: 075907 . This is a "TUFTS BENEFIT ADMIN." identifier . This identifiers is of the category "OTHER".
  • Identifier: 075907 . This is a "TUFTS COMMONWEALTH PPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 075907 . This is a "TUFTS TOTAL HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: G17464 . This is a "FIRST SENIORITY" identifier . This identifiers is of the category "OTHER".
  • Identifier: J16188 . This is a "HMO BLUE/BLUE CHOICE" identifier . This identifiers is of the category "OTHER".




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