Individual
DR. JEFFREY C ROACH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
300 MOUNT AUBURN ST, SUITE 308, CAMBRIDGE, MA 02138-5600
(616) 354-1010
(617) 354-7961
Mailing address
300 MOUNT AUBURN ST, SUITE 308, CAMBRIDGE, MA 02138-5600
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
213496
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0195871
—
MA
Enumeration date
07/09/2006
Last updated
09/26/2011
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