Healthcare Provider Details

I. General information

NPI: 1568406627
Provider Name (Legal Business Name): JOHN GALLOWAY ROTH D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 01/24/2023
Certification Date: 01/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 EAST ROLLING CROSSROADS SUITE 55
CATONSVILLE MD
21228-6212
US

IV. Provider business mailing address

1 N MAIN ST
BEL AIR MD
21014-3592
US

V. Phone/Fax

Practice location:
  • Phone: 410-455-9660
  • Fax: 410-455-9665
Mailing address:
  • Phone: 410-879-1212
  • Fax: 410-803-1859

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number00679
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number00679
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: