Provider Demographics
NPI:1275535882
Name:VERHOFF, NANCY L (MD)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:L
Last Name:VERHOFF
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 NEAL ZICK ROAD
Mailing Address - Street 2:
Mailing Address - City:WILLARD
Mailing Address - State:OH
Mailing Address - Zip Code:44890
Mailing Address - Country:US
Mailing Address - Phone:419-933-2811
Mailing Address - Fax:419-933-4502
Practice Address - Street 1:1100 NEAL ZICK ROAD
Practice Address - Street 2:
Practice Address - City:WILLARD
Practice Address - State:OH
Practice Address - Zip Code:44890
Practice Address - Country:US
Practice Address - Phone:419-933-2811
Practice Address - Fax:419-933-4502
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-12
Last Update Date:2012-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35080745207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHP00038368OtherRR MEDICARE
OH2413347Medicaid
OH2413347Medicaid
OHVE4110561Medicare UPIN