Provider Demographics
NPI:1629039375
Name:ROONEY, KATHLEEN M (PA-C)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:M
Last Name:ROONEY
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 1:123 SUMMER ST
Mailing Address - Street 2:ST VINCENT HOSPITAL
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01608-1200
Mailing Address - Country:US
Mailing Address - Phone:508-363-5718
Mailing Address - Fax:508-363-7625
Practice Address - Street 1:123 SUMMER ST
Practice Address - Street 2:ST VINCENT HOSPITAL
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01608-1200
Practice Address - Country:US
Practice Address - Phone:508-363-5718
Practice Address - Fax:508-363-7625
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2013-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA247363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAS29968Medicare UPIN
MAAP0303Medicare ID - Type UnspecifiedMEDICARE NUMBER