Provider Demographics
NPI:1417284407
Name:ROJAS, PHNONIA RAQUEL (PA)
Entity Type:Individual
Prefix:MRS
First Name:PHNONIA
Middle Name:RAQUEL
Last Name:ROJAS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7580 BUCKINGHAM BLVD STE 220
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:MD
Mailing Address - Zip Code:21076-3210
Mailing Address - Country:US
Mailing Address - Phone:410-729-5100
Mailing Address - Fax:
Practice Address - Street 1:7711 QUARTERFIELD RD
Practice Address - Street 2:SUITE A
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-4492
Practice Address - Country:US
Practice Address - Phone:410-761-5600
Practice Address - Fax:410-761-5734
Is Sole Proprietor?:No
Enumeration Date:2009-11-11
Last Update Date:2019-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0003995363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDP00794931OtherRAILROAD MEDICARE
MDP00794931OtherRAILROAD MEDICARE