Provider Demographics
NPI:1174577449
Name:ROTHROCK, JOHN F (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:F
Last Name:ROTHROCK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 37174
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21297-3174
Mailing Address - Country:US
Mailing Address - Phone:571-423-5699
Mailing Address - Fax:571-423-5698
Practice Address - Street 1:8081 INNOVATION PARK DR STE 900
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-4867
Practice Address - Country:US
Practice Address - Phone:571-472-4200
Practice Address - Fax:571-472-4201
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2022-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD0418802084N0400X
VA01012756112084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009991600Medicaid
NV1174577449Medicaid
MS00114706Medicaid
11423627OtherCAQH
FL255687100Medicaid
AL51023614OtherBCBS
AL000023614Medicaid
AL05-12000OtherUNITED HEALTHCARE
AL51509740OtherBCBS
AL000023614Medicaid
NVGJ199ZMedicare PIN
A92664Medicare UPIN
AL009991600Medicaid