Individual provider · Type 1 NPI
Laura Blake Roth, PA-C
Medical Physician Assistant · Hainesport, NJ
NPI number
1316614944
Active
Practice location
212 Creek Crossing Blvd.
Hainesport, NJ 08036
Mailing address
301 Lippincott Dr Ste 410
Marlton, NJ 08053-4197
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Medical Physician Assistant | 363AM0700X | None listed |
| Medical Physician Assistant Primary | 363AM0700X | 25MP00817500 (NJ) |
Medical Physician Assistant: Definition to come...
About NPI 1316614944
Laura Blake Roth, PA-C's National Provider Identifier is 1316614944, issued on Aug 23, 2021. The primary taxonomy on file is Medical Physician Assistant (363AM0700X), and the practice location is in Hainesport, NJ. The record was last updated on Nov 27, 2024.