Healthcare Provider Details

I. General information

NPI: 1932451689
Provider Name (Legal Business Name): MICHELLE TOMASA ROPER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MICHELLE TOMASA GANYO MD

II. Dates (important events)

Enumeration Date: 10/04/2012
Last Update Date: 05/04/2023
Certification Date: 05/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 BREWSTER BLVD
CAMP LEJEUNE NC
28547-2575
US

IV. Provider business mailing address

100 BREWSTER BLVD
CAMP LEJEUNE NC
28547-2575
US

V. Phone/Fax

Practice location:
  • Phone: 281-797-2507
  • Fax:
Mailing address:
  • Phone: 281-797-2507
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number94934
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code286500000X
TaxonomyMilitary Hospital
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number0101254549
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: