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General NPI Number Information
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NPI Number | 1851177570
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Entity Type | Organization
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Legal Business Name | BACKPACK MEDICAL GROUP, P.C.
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Dates
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Enumeration Date | 09/07/2023
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Last Update Date | 08/05/2025
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Provider Practice Location Address
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Address Line | 6655 SANTA BARBARA RD UNIT 8574
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City | ELKRIDGE
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State | MD
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Zip | 21075-7523
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Country | US
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Telephone | 866-968-6342
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Fax | 855-615-2876
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Provider Business Mailing Address
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Address Line | 6655 SANTA BARBARA RD UNIT 8574
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City | ELKRIDGE
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State | MD
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Zip | 21075-7523
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Country | US
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Telephone | 630-306-4394
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | DR. DUKE RUKTANONCHAI
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Credential | MD
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Telephone | 630-306-4394
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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