Healthcare Provider Details

I. General information

NPI: 1255029559
Provider Name (Legal Business Name): MARINA ISABEL ROCHA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2023
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 PARK LANE RD STE A101
NEW MILFORD CT
06776-2445
US

IV. Provider business mailing address

120 PARK LANE RD STE A101
NEW MILFORD CT
06776-2445
US

V. Phone/Fax

Practice location:
  • Phone: 860-355-8190
  • Fax: 860-355-3856
Mailing address:
  • Phone: 860-355-8190
  • Fax: 860-355-3856

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number84751
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: