Basic Information
| Provider Information | |||||||||
| NPI: | 1578798922 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROOTH | ||||||||
| FirstName: | KATHRYN | ||||||||
| MiddleName: | MARIE | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 101 DATES DR | ||||||||
| Address2: | |||||||||
| City: | ITHACA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 148501342 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6072744296 | ||||||||
| FaxNumber: | 6072744198 | ||||||||
| Practice Location | |||||||||
| Address1: | 701 SENECA ST STE 646C | ||||||||
| Address2: | |||||||||
| City: | BUFFALO | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142101351 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7169954450 | ||||||||
| FaxNumber: | 8442067424 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/28/2009 | ||||||||
| LastUpdateDate: | 07/22/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/22/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 266513 | NY | N | Allopathic & Osteopathic Physicians | Pediatrics | 208M00000X | 266513 | NY | Y | Allopathic & Osteopathic Physicians | Hospitalist |
No ID Information.