Healthcare Provider Details

I. General information

NPI: 1609570084
Provider Name (Legal Business Name): KATHERINE ROOF DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHERINE HAUSRATH

II. Dates (important events)

Enumeration Date: 03/29/2023
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7711 QUARTERFIELD RD STE A
GLEN BURNIE MD
21061-4492
US

IV. Provider business mailing address

7580 BUCKINGHAM BLVD STE 220
HANOVER MD
21076-3210
US

V. Phone/Fax

Practice location:
  • Phone: 410-761-5600
  • Fax: 410-761-5734
Mailing address:
  • Phone: 410-729-5100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberH0106577
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: