Active NPI
Mark David Roth, MA
- Behavior Analyst
- Bangor, ME
National Provider Identifier
1356651640
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Analyst
- License
- 198
- Practice address
- 118 Maple St
Bangor, ME 04401-4032 - Phone
- (207) 947-3628
- NPI assigned
- Oct 20, 2010
- 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 |
|---|---|---|---|---|
| Behavior Analyst | 103K00000X | 198 | ME | Primary |
Addresses
Primary practice location
118 Maple St
Bangor, ME 04401-4032
Mailing address
118 Maple St
Bangor, ME 04401-4032
Phone (207) 947-3628
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
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 198 | ME | MD | Behavioral Analyst |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1287532800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1287532800000",
"number": "1356651640",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "118 MAPLE ST",
"city": "BANGOR",
"state": "ME",
"postal_code": "044014032",
"telephone_number": "207-947-3628"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "118 MAPLE ST",
"city": "BANGOR",
"state": "ME",
"postal_code": "044014032",
"telephone_number": "207-947-3628"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROTH",
"first_name": "MARK",
"middle_name": "DAVID",
"name_prefix": "Mr.",
"credential": "MA",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2010-10-20",
"last_updated": "2010-10-20",
"status": "A"
},
"taxonomies": [
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": "ME",
"license": "198",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bangor, ME
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.