Healthcare Provider Details

I. General information

NPI: 1023266178
Provider Name (Legal Business Name): MAURICIO ROJAS MANUEL JR. PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JOEL MANUEL

II. Dates (important events)

Enumeration Date: 09/03/2008
Last Update Date: 08/07/2025
Certification Date: 07/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 KENSINGTON PKWY
ABINGDON MD
21009-1851
US

IV. Provider business mailing address

55 KENSINGTON PKWY
ABINGDON MD
21009-1851
US

V. Phone/Fax

Practice location:
  • Phone: 410-569-5162
  • Fax: 410-569-1008
Mailing address:
  • Phone: 410-569-5162
  • Fax: 410-569-1008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC0002075
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberCOO02075
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: