Provider Demographics
NPI:1073757605
Name:ROCKWOOD, CARA LOUISE (PA-C)
Entity type:Individual
Prefix:
First Name:CARA
Middle Name:LOUISE
Last Name:ROCKWOOD
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 1:149 EMERALD ST UNIT U
Mailing Address - Street 2:
Mailing Address - City:KEENE
Mailing Address - State:NH
Mailing Address - Zip Code:03431-3660
Mailing Address - Country:US
Mailing Address - Phone:978-513-7645
Mailing Address - Fax:
Practice Address - Street 1:149 EMERALD ST UNIT U
Practice Address - Street 2:
Practice Address - City:KEENE
Practice Address - State:NH
Practice Address - Zip Code:03431-3660
Practice Address - Country:US
Practice Address - Phone:978-513-7645
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-27
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA61471747363A00000X
OH50-001647363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2258222Medicaid
OH50-001647OtherOHIO STATE LICENSE NUMBER