Look up the most recent NPI and PECOS records

Charles J. Roth

Physician Assistant

Physician Assistants & Advanced Practice Nursing Providers

PECOS Enrollment

Based on the most recent information from CMS, provider Charles J. Roth does not have current enrollment records in PECOS.

Part B
Medicare Part B
Not Enrolled
HHA
Home Health Agency
Not Enrolled
DME
Durable Medical Equipment
Not Enrolled
PMD
Power Mobility Device
Not Enrolled

CMS last updated its PECOS records yesterday at 2:35 PM.

Profile Details

Provider ID
1740305226
Provider Type
Individual
Full Name
Roth, Charles J.
Credential
PA-C

Gender
Male
Sole Proprietor
No
Enumeration Date
3/21/2007
Last Updated
9/9/2021

Contact Information

Practice Location

33 Sewall St, Portland, ME 04102-2603

(207) 828-2100

Unlisted Fax

Mailing Location

324 Gannett Dr Ste 200, South Portland, ME 04106-3266

(207) 482-7800

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 363A00000X Primary	Description Physician Assistant Physician Assistants & Advanced Practice Nursing Providers	License PA628 Maine

Provider Identifiers

ID	Description	Issuer
ID 1740305226	Description Medicaid	Issuer Unlisted Maine

Charles J. Roth

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Provider Identifiers

ID

Description

Issuer

ID

Description

Issuer

Pearson, Melinda M

Lavoie, Sarah A

Sepulveda, Louis

Manley, Bruce G

Bothel, Cody

Bessey, Kristie L

Mccrossin, Megan A

O'Day, Erin Rose

Landry, Addison

Jones, Rhianna