Provider Demographics
NPI:1306839113
Name:STROH, JOHN W (DPM)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:W
Last Name:STROH
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:915 TOLL HOUSE AVE
Mailing Address - Street 2:#207
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21701-5930
Mailing Address - Country:US
Mailing Address - Phone:301-663-6861
Mailing Address - Fax:301-663-0095
Practice Address - Street 1:915 TOLL HOUSE AVE
Practice Address - Street 2:#207
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-5930
Practice Address - Country:US
Practice Address - Phone:301-663-6861
Practice Address - Fax:301-663-0095
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-26
Last Update Date:2010-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD00285213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD528388400Medicaid
T59844Medicare UPIN
664B306LMedicare ID - Type Unspecified