Healthcare Provider Details

I. General information

NPI: 1043690993
Provider Name (Legal Business Name): ROOPA PANDIT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2015
Last Update Date: 03/22/2021
Certification Date: 03/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1475 MOUNT HOOD AVE
WOODBURN OR
97071
US

IV. Provider business mailing address

1475 MOUNT HOOD AVE
WOODBURN OR
97071-9066
US

V. Phone/Fax

Practice location:
  • Phone: 503-982-0626
  • Fax: 503-981-1509
Mailing address:
  • Phone: 503-982-0626
  • Fax: 503-981-1509

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301107947
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD188247
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: