Provider Demographics
NPI:1912191453
Name:ROFF, NATHALIE K (MD)
Entity Type:Individual
Prefix:
First Name:NATHALIE
Middle Name:K
Last Name:ROFF
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:NATHALIE
Other - Middle Name:K
Other - Last Name:ROFF
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:25 1/2 COURTLANDT PL
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77006-4013
Mailing Address - Country:US
Mailing Address - Phone:713-522-1240
Mailing Address - Fax:832-218-9148
Practice Address - Street 1:6550 FANNIN ST STE 657
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2717
Practice Address - Country:US
Practice Address - Phone:713-441-2235
Practice Address - Fax:346-238-0122
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-28
Last Update Date:2020-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ9546261Q00000X, 261QP2300X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX398634101Medicaid