Provider Demographics
NPI:1104476167
Name:ROFF, CARL DEAN
Entity type:Individual
Prefix:MR
First Name:CARL
Middle Name:DEAN
Last Name:ROFF
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4411 LUCILLE AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44121-3538
Mailing Address - Country:US
Mailing Address - Phone:440-591-9967
Mailing Address - Fax:
Practice Address - Street 1:4411 LUCILLE AVE
Practice Address - Street 2:
Practice Address - City:SOUTH EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44121-3538
Practice Address - Country:US
Practice Address - Phone:440-591-9967
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-12
Last Update Date:2019-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist