| Doctor Name: | MAUREEN A ROETH |
| NPI Number: | 1427150218 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | FNP |
| License Number: | F332985-1 |
| Business Practice Address: | 3 Mercycare Ln Guilderland, NY - 120843504 |
| Business Phone Number: | 5184526760 |
| Business Fax Number: | 5184526756 |
| Mailing Address: | 58 Daniel St, SLINGERLANDS |
| State: | NY |
| Postal Code: | 121599758 |
| Phone Number: | 5184398498 |
| Fax Number: | |
| NPI Enumeration Date: | 09/02/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | F332985-1 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |