Provider Demographics
NPI:1659502763
Name:ROOP, KATRINA MARIE (DO)
Entity Type:Individual
Prefix:DR
First Name:KATRINA
Middle Name:MARIE
Last Name:ROOP
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 284
Mailing Address - Street 2:
Mailing Address - City:BRATTLEBORO
Mailing Address - State:VT
Mailing Address - Zip Code:05302-0284
Mailing Address - Country:US
Mailing Address - Phone:207-602-3571
Mailing Address - Fax:207-602-3573
Practice Address - Street 1:208 GRAHAM ST
Practice Address - Street 2:
Practice Address - City:BIDDEFORD
Practice Address - State:ME
Practice Address - Zip Code:04005-3853
Practice Address - Country:US
Practice Address - Phone:207-602-3571
Practice Address - Fax:207-602-3573
Is Sole Proprietor?:No
Enumeration Date:2009-08-06
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP6712204D00000X, 207Q00000X
FLOS10510207Q00000X
MEDO3748207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX331456902OtherMEDICAID - OTHER COUNTY
TX339886YL7AOtherMEDICARE - OTHER COUNTY
TX331456901Medicaid
TXP01427305OtherRAILROAD MEDICARE PTAN
TX339886YNGSMedicare PIN