Healthcare Provider Details

I. General information

NPI: 1720359797
Provider Name (Legal Business Name): MARY ROATCH P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARY DRAGOO

II. Dates (important events)

Enumeration Date: 01/23/2012
Last Update Date: 10/15/2025
Certification Date: 10/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

999 17TH ST STE 500
DENVER CO
80202-2728
US

IV. Provider business mailing address

999 17TH ST STE 500
DENVER CO
80202-2728
US

V. Phone/Fax

Practice location:
  • Phone: 720-434-4876
  • Fax: 303-225-4246
Mailing address:
  • Phone: 720-434-4876
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number3336
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: