Provider Demographics
NPI:1548562473
Name:PATRICIA L. ROONEY, D.O., P.A.
Entity Type:Organization
Organization Name:PATRICIA L. ROONEY, D.O., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:ROONEY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:954-982-0088
Mailing Address - Street 1:2312 NE 53RD ST
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-3212
Mailing Address - Country:US
Mailing Address - Phone:954-928-0088
Mailing Address - Fax:954-928-1871
Practice Address - Street 1:2312 NE 53RD ST
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-3212
Practice Address - Country:US
Practice Address - Phone:954-928-0088
Practice Address - Fax:954-928-1871
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-29
Last Update Date:2010-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS52962086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL80252AMedicare UPIN