Provider Demographics
NPI:1972856599
Name:MOOPEN, VINITHA (MD)
Entity Type:Individual
Prefix:
First Name:VINITHA
Middle Name:
Last Name:MOOPEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:2320 ROTHSVILLE RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LITITZ
Mailing Address - State:PA
Mailing Address - Zip Code:17543-8215
Mailing Address - Country:US
Mailing Address - Phone:717-721-4800
Mailing Address - Fax:717-626-1613
Practice Address - Street 1:2320 ROTHSVILLE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:LITITZ
Practice Address - State:PA
Practice Address - Zip Code:17543-8215
Practice Address - Country:US
Practice Address - Phone:717-721-4800
Practice Address - Fax:717-626-1613
Is Sole Proprietor?:No
Enumeration Date:2012-10-19
Last Update Date:2015-10-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD435309208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102764438Medicaid