Provider Demographics
NPI:1730398173
Name:ROTH, YOLANDA FAITH (MD)
Entity type:Individual
Prefix:DR
First Name:YOLANDA
Middle Name:FAITH
Last Name:ROTH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:YOLANDA
Other - Middle Name:ROTH
Other - Last Name:MOYER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:7723 IVYMOUNT TER
Mailing Address - Street 2:
Mailing Address - City:POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20854-3216
Mailing Address - Country:US
Mailing Address - Phone:301-983-8065
Mailing Address - Fax:
Practice Address - Street 1:7723 IVYMOUNT TER
Practice Address - Street 2:
Practice Address - City:POTOMAC
Practice Address - State:MD
Practice Address - Zip Code:20854-3216
Practice Address - Country:US
Practice Address - Phone:301-983-8065
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2012-10-18
Deactivation Date:2007-07-18
Deactivation Code:
Reactivation Date:2012-10-18
Provider Licenses
StateLicense IDTaxonomies
MDD31212174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDB70233Medicare UPIN