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DR. ROBERT MARK ROTH PHD

Clinical Neuropsychologist

Lebanon, New Hampshire

Provider NPI: 1891863106

Provider Information:
DR. ROBERT MARK ROTH PHD
Gender: M
Not Sole Proprietor

Practice Location:
1 MEDICAL CENTER DRIVE  LEBANON, NH 03756 US
Tel: 603-650-7232  Fax: 603-650-9478

Business Mailing Address:
1 MEDICAL CENTER DRIVE  LEBANON, NH 03756 US
Tel: 603-650-7232  Fax: 603-650-9478

Entity Type: Individual

Taxonomy:

PrimaryCodeCategory/DescriptionStateLicense Number
Y103G00000XBehavioral Health & Social Service Providers
Clinical Neuropsychologist
NH974

Other Provider Identifiers:

IssuerNumberStateType
MEDICAID1008316VT01
30421662NH05
Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin







CLINICAL NEUROPSYCHOLOGIST JOBS NH - Page 1



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