Provider Demographics
NPI:1063886372
Name:NATHALIE K ROFF, MD PA
Entity type:Organization
Organization Name:NATHALIE K ROFF, MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NATHALIE
Authorized Official - Middle Name:K
Authorized Official - Last Name:ROFF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-522-1240
Mailing Address - Street 1:25 1/2 COURTLANDT PLACE
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.
Practice Address - Street 2:SUITE 657
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:832-218-9148
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-24
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ9546261Q00000X, 282E00000X, 282N00000X, 284300000X, 314000000X
261Q00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Multi-Specialty
No282E00000XHospitalsLong Term Care Hospital
No282N00000XHospitalsGeneral Acute Care Hospital
No284300000XHospitalsSpecial Hospital
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing FacilityGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX398634101Medicaid