1013348044 NPI number — DR JOHN G ROTH & ASSOCIATES PA

Table of content: (NPI 1013348044)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013348044 NPI number — DR JOHN G ROTH & ASSOCIATES PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DR JOHN G ROTH & ASSOCIATES PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1013348044
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/20/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

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

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2 E ROLLING CROSSROADS
Provider Second Line Business Practice Location Address:
SUITE 55
Provider Business Practice Location Address City Name:
CATONSVILLE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21228-6211
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-455-9660
Provider Business Practice Location Address Fax Number:
410-455-9665
Provider Enumeration Date:
12/02/2013

Additional Information

Authorized Official

Authorized Official Last Name:
ROTH
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
G
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
410-455-9660

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X , with the licence number:  00697 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 480006823 . This is a "PALMETTO GBA RAILROAD MEDICARE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 31463 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 4309156 . This is a "AETNA" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 104879 . This is a "JOHNS HOPKINS - EHP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 27-00297 . This is a "UNITED HEALTHCARE OF THE MID-ATLANTIC" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 408078500 . This is a "MEDICAID" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 701034P . This is a "CIGNA" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: T210-JG-48 . This is a "CAREFIRST BCBS OFMD" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 77530002 . This is a "BLUECHOICE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 77530002 . This is a "BC FEDERAL/NATIONAL CAPITOL AREA" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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