Provider Demographics
NPI:1437350683
Name:ELIZABETH ROAF MD
Entity Type:Organization
Organization Name:ELIZABETH ROAF MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:ROAF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:508-471-9502
Mailing Address - Street 1:PO BOX 388
Mailing Address - Street 2:
Mailing Address - City:BOLTON
Mailing Address - State:MA
Mailing Address - Zip Code:01740
Mailing Address - Country:US
Mailing Address - Phone:508-471-9502
Mailing Address - Fax:508-791-8180
Practice Address - Street 1:189 MAY STREET
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01602
Practice Address - Country:US
Practice Address - Phone:508-471-9502
Practice Address - Fax:508-791-8180
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081H0002XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationHospice and Palliative MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3169839Medicaid
MAA22782Medicare ID - Type UnspecifiedINDIVIDUAL
650923Medicare UPIN