MEDICARE: JOHN ROTH, DPM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies	00679	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	31463	OTHER	MD	UNITED HEALTHCARE
2	77530002	OTHER	MD	CAREFIRST BLUECHOICE
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	27-00297	OTHER	MD	UNITED HEALTHCARE OF MID-ATLANTIC
5	4309156	OTHER	MD	AETNA
6	T210	OTHER	MD	CAREFIRST BLUECROSS BLUESHIELD

General Provider Information

NPI Number	:	1164730214
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOHN ROTH, DPM

Provider Business Mailing Address
First Line	:	2 E ROLLING CROSSROADS
Second Line	:	SUITE 55
City	:	CATONSVILLE
State	:	MD
Zip	:	21228-6211
Country	:	US
Telephone Number	:	410-455-9660
Fax Number	:	410-455-9665

Provider Business Practice Location Address
First Line	:	2 E ROLLING CROSSROADS
Second Line	:	SUITE 55
City	:	CATONSVILLE
State	:	MD
Zip	:	21228-6211
Country	:	US
Telephone Number	:	410-455-9660
Fax Number	:	410-455-9665

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JOHN ROTH
Credential	:	DPM
Telephone Number	:	410-455-9660

Provider Enumeration Date	:	09/22/2010
Last Update Date	:	10/21/2010

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Directions to “JOHN ROTH, DPM ” Practice Location

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