Provider Demographics
NPI:1528027547
Name:ROOF, KEVIN S (MD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:S
Last Name:ROOF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 QUEENS RD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28204-3253
Mailing Address - Country:US
Mailing Address - Phone:704-333-7376
Mailing Address - Fax:704-333-3397
Practice Address - Street 1:170 MEDICAL PARK RD
Practice Address - Street 2:SUITE 100
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-8540
Practice Address - Country:US
Practice Address - Phone:704-235-2599
Practice Address - Fax:704-333-3397
Is Sole Proprietor?:No
Enumeration Date:2006-03-20
Last Update Date:2012-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2004004072085R0001X
SC266852085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC136TKOtherBLUE CROSS
D5200OtherMEDCOST
804283OtherPARTNERS
NC89136TKMedicaid
SCN07004Medicaid
2474226OtherUNITED HEALTHCARE
2862751OtherCIGNA
2862751OtherCIGNA
SCI061536058Medicare ID - Type UnspecifiedSC MEDICARE
NCI06153Medicare UPIN
SCP00263288Medicare ID - Type UnspecifiedRAILROAD MEDICARE
NC2021693BMedicare ID - Type UnspecifiedUNIVERSITY RAD ONC CTR
NC2021693AMedicare ID - Type UnspecifiedMATTHEWS RAD ONC CTR
SCN07004Medicaid