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NPI Code Detail

MEDICARE: REILLY ROCHE APRN

MEDICARE: REILLY ROCHE APRN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse PractitionerRN2333905MA

General Provider Information

NPI Number : 1720938913
Entity Type Code : Individual
Provider Name (Legal Business Name) : REILLY ROCHE APRN
Provider Business Mailing Address
First Line : 85 HIGH ST
Second Line :
City : MEDFORD
State : MA
Zip : 02155-3825
Country : US
Telephone Number : 866-389-2727
Fax Number :
Provider Business Practice Location Address
First Line : 85 HIGH ST
Second Line :
City : MEDFORD
State : MA
Zip : 02155-3825
Country : US
Telephone Number : 781-396-4770
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/29/2026
Last Update Date : 03/13/2026

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Directions to “ REILLY ROCHE APRN” Practice Location

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