MEDICARE: HEATHER LYNN ROACH 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	MA056332	PA

General Provider Information

NPI Number	:	1477988780
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEATHER LYNN ROACH PA-C

Provider Business Mailing Address
First Line	:	3509 N BROAD ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19140-4105
Country	:	US
Telephone Number	:	215-707-2433
Fax Number	:

Provider Business Practice Location Address
First Line	:	3509 N BROAD ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19140-4105
Country	:	US
Telephone Number	:	215-707-2111
Fax Number	:

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

Provider Enumeration Date	:	09/05/2013
Last Update Date	:	01/23/2026

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Directions to “ HEATHER LYNN ROACH PA-C” Practice Location

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