Healthcare Provider Details

I. General information

NPI: 1427388461
Provider Name (Legal Business Name): KATHERINE L. BOXBERGER PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHERINE L. ROACHE

II. Dates (important events)

Enumeration Date: 01/13/2010
Last Update Date: 01/05/2026
Certification Date: 01/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 DIVISION ST
DERBY CT
06418-1326
US

IV. Provider business mailing address

67 MAPLE AVE
DERBY CT
06418-1328
US

V. Phone/Fax

Practice location:
  • Phone: 203-732-7252
  • Fax: 203-732-1539
Mailing address:
  • Phone: 203-732-7252
  • Fax: 203-732-1539

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number002336
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number002336
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: