Provider Demographics
NPI:1669747911
Name:ROOPER, LISA (MD)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:ROOPER
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 1:2703 GLEN AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21215-4108
Mailing Address - Country:US
Mailing Address - Phone:847-417-7614
Mailing Address - Fax:
Practice Address - Street 1:401 NORTH BROADWAY
Practice Address - Street 2:WEINBERG BUILDING, SUITE 2242
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21231-2410
Practice Address - Country:US
Practice Address - Phone:410-955-3580
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-20
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0080766207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology