Provider Demographics
NPI:1003995218
Name:CHRISTOFORETTI, JOHN JOSEPH II (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:JOSEPH
Last Name:CHRISTOFORETTI
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6710A ROCKLEDGE DR STE 130
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20817-2843
Mailing Address - Country:US
Mailing Address - Phone:301-515-0900
Mailing Address - Fax:240-912-2381
Practice Address - Street 1:6710A ROCKLEDGE DR STE 130
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20817-2843
Practice Address - Country:US
Practice Address - Phone:301-515-0900
Practice Address - Fax:240-912-2381
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD96899207X00000X, 207XX0005X
TXR9478207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102003882Medicaid
PA113187Medicare PIN
I68758Medicare UPIN