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General NPI Number Information
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NPI Number | 1013348044
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Entity Type | Organization
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Legal Business Name | DR JOHN G ROTH & ASSOCIATES PA
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Dates
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Enumeration Date | 12/02/2013
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Last Update Date | 12/20/2013
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Provider Practice Location Address
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Address Line | 2 E ROLLING CROSSROADS SUITE 55
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City | CATONSVILLE
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State | MD
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Zip | 21228-6211
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Country | US
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Telephone | 410-455-9660
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Fax | 410-455-9665
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Provider Business Mailing Address
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Address Line | 2 E ROLLING CROSSROADS SUITE 55
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City | CATONSVILLE
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State | MD
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Zip | 21228-6211
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Country | US
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Telephone | 410-455-9660
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Fax | 410-455-9665
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Authorized Official
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Title or Position | OWNER
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Name | DR. JOHN G ROTH
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Credential | D.P.M.
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Telephone | 410-455-9660
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 00697
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License Number State | MD
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