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General NPI Number Information
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NPI Number | 1982172946
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Entity Type | Individual
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Provider Name | ROOPA MUKUND PA-C
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Gender | Female
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Dates
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Enumeration Date | 11/07/2018
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Last Update Date | 04/29/2024
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Provider Practice Location Address
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Address Line | 101 N EAST PLZ
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City | NORTH EAST
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State | MD
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Zip | 21901-3633
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Country | US
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Telephone | 410-656-7867
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Fax | 443-877-6784
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Provider Business Mailing Address
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Address Line | 751 CHATEAUS DR
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City | COPPELL
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State | TX
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Zip | 75019-4591
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Country | US
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Telephone | 972-896-4790
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 56233
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 0110009790
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 56233
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA216572
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License Number State | OR
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Taxonomy #5
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA13220
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License Number State | TX
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Taxonomy #6
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | C0009349
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License Number State | MD
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