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General NPI Number Information
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NPI Number | 1528027547
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Entity Type | Individual
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Provider Name | KEVIN S ROOF M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/20/2006
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Last Update Date | 11/14/2012
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Provider Practice Location Address
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Address Line | 170 MEDICAL PARK RD SUITE 100
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City | MOORESVILLE
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State | NC
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Zip | 28117-8540
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Country | US
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Telephone | 704-235-2599
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Fax | 704-333-3397
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Provider Business Mailing Address
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Address Line | 200 QUEENS RD SUITE 400
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City | CHARLOTTE
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State | NC
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Zip | 28204-3253
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Country | US
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Telephone | 704-333-7376
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Fax | 704-333-3397
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0001X
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Taxonomy Name | Radiation Oncology Physician
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License Number | 200400407
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 2085R0001X
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Taxonomy Name | Radiation Oncology Physician
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License Number | 26685
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License Number State | SC
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