Provider Demographics
NPI:1033293931
Name:PROPATO, LANDA ROSE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:LANDA
Middle Name:ROSE
Last Name:PROPATO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5000 COX RD
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23060-9263
Mailing Address - Country:US
Mailing Address - Phone:804-968-5700
Mailing Address - Fax:
Practice Address - Street 1:713 BETHLEHEM PIKE
Practice Address - Street 2:
Practice Address - City:MONTGOMERYVILLE
Practice Address - State:PA
Practice Address - Zip Code:18936-9602
Practice Address - Country:US
Practice Address - Phone:267-695-3944
Practice Address - Fax:267-695-3945
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2018-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA051597363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA221816YEXCOtherMEDICARE PTAN
PA221816YEXCOtherMEDICARE PTAN
PA295943YEBKMedicare PIN