MEDICARE: MR. ZACHARY C. ROACH MPH, PA-C

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
1	363A00000X	Physician Assistant
2	363AM0700X	Medical Physician Assistant

General Provider Information

NPI Number	:	1467942128
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ZACHARY C. ROACH MPH, PA-C

Provider Business Mailing Address
First Line	:	1650 PENNSYLVANIA AVE NW
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20502-0001
Country	:	US
Telephone Number	:	202-757-2499
Fax Number	:	757-953-7560

Provider Business Practice Location Address
First Line	:	1650 PENNSYLVANIA AVE NW
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20502-0001
Country	:	US
Telephone Number	:	202-757-2499
Fax Number	:	757-953-7560

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/17/2018
Last Update Date	:	01/22/2025

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