Healthcare Provider Details

I. General information

NPI: 1265674634
Provider Name (Legal Business Name): ROOHI YASMIN ABDULLA KHAROFA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2009
Last Update Date: 02/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3050 MACK ROAD ML 11032
CINCINNATI OH
45014-5379
US

IV. Provider business mailing address

3050 MACK ROAD ML 11032
FAIRFIELD OH
45014-5379
US

V. Phone/Fax

Practice location:
  • Phone: 513-636-8259
  • Fax: 513-636-6419
Mailing address:
  • Phone: 513-636-8259
  • Fax: 513-636-6419

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number55321
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35.123501
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: