Provider Demographics
NPI:1467465138
Name:SOOD-KHANDPUR, ROOPAM (MD)
Entity Type:Individual
Prefix:
First Name:ROOPAM
Middle Name:
Last Name:SOOD-KHANDPUR
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 1:5309 SHOAL CREEK RD
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23435-4228
Mailing Address - Country:US
Mailing Address - Phone:757-968-3130
Mailing Address - Fax:
Practice Address - Street 1:100 EMANCIPATION DR
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23667-3160
Practice Address - Country:US
Practice Address - Phone:757-803-5505
Practice Address - Fax:443-512-2834
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01012372572084P0800X, 2084P0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA008657H26Medicare ID - Type Unspecified
VAI00955Medicare UPIN