Healthcare Provider Details

I. General information

NPI: 1316194590
Provider Name (Legal Business Name): TEIA ROCHA PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TEIA FINCH

II. Dates (important events)

Enumeration Date: 08/19/2008
Last Update Date: 03/16/2022
Certification Date: 03/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8105 RITCHIE HWY
PASADENA MD
21122-3905
US

IV. Provider business mailing address

5000 COX RD
GLEN ALLEN VA
23060-9263
US

V. Phone/Fax

Practice location:
  • Phone: 443-573-0564
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberC0003673
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: