Individual
DR. KEVIN S ROOF
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
170 MEDICAL PARK RD, SUITE 100, MOORESVILLE, NC 28117-8540
(704) 235-2599
(704) 333-3397
Mailing address
200 QUEENS RD, SUITE 400, CHARLOTTE, NC 28204-3253
(704) 333-7376
(704) 333-3397
Taxonomy
Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
Primary
200400407
NC
2085R0001X
Radiation Oncology Physician
26685
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
136TK
BLUE CROSS
NC
01
—
2474226
UNITED HEALTHCARE
—
01
—
2862751
CIGNA
—
01
—
804283
PARTNERS
—
05
—
89136TK
—
NC
01
—
D5200
MEDCOST
—
05
—
N07004
—
SC
Enumeration date
03/20/2006
Last updated
11/14/2012
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