MEDICARE: BRIAN T ROACH

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	172A00000X	Driver	RV003379	OH

General Provider Information

NPI Number	:	1518815596
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIAN T ROACH

Provider Business Mailing Address
First Line	:	11331 MAHONING AVE
Second Line	:
City	:	NORTH JACKSON
State	:	OH
Zip	:	44451-9618
Country	:	US
Telephone Number	:	330-437-6350
Fax Number	:

Provider Business Practice Location Address
First Line	:	11331 MAHONING AVE
Second Line	:
City	:	NORTH JACKSON
State	:	OH
Zip	:	44451-9618
Country	:	US
Telephone Number	:	330-437-6350
Fax Number	:

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

Provider Enumeration Date	:	03/17/2026
Last Update Date	:	03/17/2026

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Directions to “ BRIAN T ROACH ” Practice Location

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