Laura Blake Roth, PA-C
Physician Assistant, Medical in Hainesport, NJ. Individual provider (NPI-1).
NPI number1316614944
StatusActive
Last updated in NPPESNov 27, 2024
Details
- NPI
- 1316614944
- Entity type
- Individual (NPI-1)
- Name
- Laura Blake Roth
- Credential
- PA-C
- Sex
- Female
- Sole proprietor
- Yes
- Enumeration date
- Aug 23, 2021
- Certification date
- Nov 27, 2024
- Last updated
- Nov 27, 2024
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363AM0700X | Physician Assistant, Medical | 25MP00817500 | NJ | Yes |
| 363AM0700X | Physician Assistant, Medical | – | – |
Practice location
212 Creek Crossing Blvd.Hainesport, NJ 08036
Phone 856-206-4795
Mailing address
301 Lippincott Dr Ste 410Marlton, NJ 08053-4197
Phone 856-247-7210 · Fax 856-247-7511
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