Provider Demographics
NPI:1194566711
Name:ROACH, JAMES R
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:R
Last Name:ROACH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4700 CEDELL PL
Mailing Address - Street 2:
Mailing Address - City:TEMPLE HILLS
Mailing Address - State:MD
Mailing Address - Zip Code:20748-3809
Mailing Address - Country:US
Mailing Address - Phone:202-860-8431
Mailing Address - Fax:
Practice Address - Street 1:5201 CONNECTICUT AVE NW APT 311
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20015-1841
Practice Address - Country:US
Practice Address - Phone:202-860-8431
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-06
Last Update Date:2024-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant