Provider Demographics
NPI:1568406627
Name:ROTH, JOHN GALLOWAY (DPM)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:GALLOWAY
Last Name:ROTH
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21014-3592
Mailing Address - Country:US
Mailing Address - Phone:410-879-1212
Mailing Address - Fax:410-803-1859
Practice Address - Street 1:2 EAST ROLLING CROSSROADS
Practice Address - Street 2:SUITE 55
Practice Address - City:CATONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21228-6212
Practice Address - Country:US
Practice Address - Phone:410-455-9660
Practice Address - Fax:410-455-9665
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD00679213ES0103X, 213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD64726770001OtherMCNSC
MD104879OtherEMPLOYEES HEALTH PLAN
MD4309156OtherAETNA
MD521605554OtherTRICARE
MD77530002OtherBC FEDERAL/NAT'L CAPITOL
MDT210-JG-48OtherCAREFIRST BCBS OF MD
MD27-00382-ECOtherUNITEDHEALTHCARE MID ATL
MD408078500Medicaid
MD213549OtherMAMSI/ALLIANCE
MD31463OtherUNITEDHEALTHCARE
MD521605554OtherCOVENTRY HEALTH CARE
MD521605554OtherFIDELITY
MD521605554OtherGEHA
MD701034POtherCIGNA
MD77530002OtherBLUECHOICE
MDT210OtherPALMETTO GBA RAILROAD MC
MD27-00297-SCOtherUNITEDHEALTHCARE MID-ATL
MD521605554OtherAARP
MD27-00297-SCOtherUNITEDHEALTHCARE MID-ATL
MD521605554OtherAARP