Active NPI
Erlo Roth, M.D.
- Anatomic Pathology & Clinical Pathology Physician
- Hinsdale, IL
National Provider Identifier
1104053982
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Anatomic Pathology & Clinical Pathology Physician
- License
- 036050827
- Practice address
- 120 E Ogden Ave Ste 14
Hinsdale, IL 60521-3544 - Phone
- (630) 986-9622
- Fax
- (630) 986-0720
- NPI assigned
- Jun 18, 2009
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Anatomic Pathology & Clinical Pathology Physician | 207ZP0102X | 036050827 | IL | Primary |
Addresses
Primary practice location
120 E Ogden Ave Ste 14
Hinsdale, IL 60521-3544
Mailing address
120 E Ogden Ave Ste 14
Hinsdale, IL 60521-3544
Phone (630) 986-9622
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 036050827 | IL | MD | Anatomic Pathology & Clinical Pathology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1245283200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1245283200000",
"number": "1104053982",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "120 E OGDEN AVE STE 14",
"city": "HINSDALE",
"state": "IL",
"postal_code": "605213544",
"telephone_number": "630-986-9622",
"fax_number": "630-986-0720"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "120 E OGDEN AVE STE 14",
"city": "HINSDALE",
"state": "IL",
"postal_code": "605213544",
"telephone_number": "630-986-9622",
"fax_number": "630-986-0720"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROTH",
"first_name": "ERLO",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2009-06-18",
"last_updated": "2009-06-18",
"status": "A"
},
"taxonomies": [
{
"code": "207ZP0102X",
"taxonomy_group": "",
"desc": "Pathology, Anatomic Pathology & Clinical Pathology",
"state": "IL",
"license": "036050827",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Hinsdale, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.