Healthcare Provider Details

I. General information

NPI: 1649292640
Provider Name (Legal Business Name): WALTER HELMUT ROHLOFF MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 12/03/2023
Certification Date: 12/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9149 ESTATE THOMAS STE 209A
ST THOMAS VI
00802-3132
US

IV. Provider business mailing address

9149 ESTATE THOMAS STE 209A
ST THOMAS VI
00802-3132
US

V. Phone/Fax

Practice location:
  • Phone: 505-563-2800
  • Fax: 505-563-2821
Mailing address:
  • Phone: 340-998-1401
  • Fax: 800-860-0677

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number1915
License Number StateVI
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number2001-296
License Number StateNM
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number1915
License Number StateVI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: