Individual
KEVIN JON ROELOFS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
100 GRIFFIN RD, UNIT A, PORTSMOUTH, NH 03801-7158
(603) 436-7897
(603) 436-7855
Mailing address
100 GRIFFIN RD, UNIT A, PORTSMOUTH, NH 03801-7158
Taxonomy
Speciality
Code
Description
License number
State
207KA0200X
Allergy Physician
Primary
12404
NH
2080P0201X
Pediatric Allergy/Immunology Physician
12404
NH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01Y007809NH01
ANTHEM NH ID #
NH
05
—
30204663
—
NH
Enumeration date
07/05/2005
Last updated
08/31/2021
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