Provider Demographics
NPI:1164730214
Name:JOHN ROTH, DPM
Entity Type:Organization
Organization Name:JOHN ROTH, DPM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROTH
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:410-455-9660
Mailing Address - Street 1:2 E ROLLING CROSSROADS
Mailing Address - Street 2:SUITE 55
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-6211
Mailing Address - Country:US
Mailing Address - Phone:410-455-9660
Mailing Address - Fax:410-455-9665
Practice Address - Street 1:2 E ROLLING CROSSROADS
Practice Address - Street 2:SUITE 55
Practice Address - City:CATONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21228-6211
Practice Address - Country:US
Practice Address - Phone:410-455-9660
Practice Address - Fax:410-455-9665
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-22
Last Update Date:2010-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD00679332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD31463OtherUNITED HEALTHCARE
MD77530002OtherCAREFIRST BLUECHOICE
MD408078500Medicaid
MD27-00297OtherUNITED HEALTHCARE OF MID-ATLANTIC
MD4309156OtherAETNA
MDT210OtherCAREFIRST BLUECROSS BLUESHIELD
MD77530002OtherCAREFIRST BLUECHOICE