Provider Demographics
NPI:1164127767
Name:ROOBLE, FNU (MD)
Entity Type:Individual
Prefix:
First Name:FNU
Middle Name:
Last Name:ROOBLE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:THE WRIGHT CENTER FOR GRADUATE MEDICAL EDUCATION
Mailing Address - Street 2:501 S. WASHINGTON AVE, SUITE 1000
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18505
Mailing Address - Country:US
Mailing Address - Phone:570-866-3058
Mailing Address - Fax:
Practice Address - Street 1:501 S. WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18505
Practice Address - Country:US
Practice Address - Phone:570-866-3058
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-03
Last Update Date:2024-01-23
Deactivation Date:2023-11-06
Deactivation Code:
Reactivation Date:2023-11-21
Provider Licenses
StateLicense IDTaxonomies
390200000X
PAMT2286642084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMT228664OtherTRAINING LICENSE