MEDICARE: KATHRYN A ROACH CRNA

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	367500000X	Certified Registered Nurse Anesthetist	RN275991L	PA

General Provider Information

NPI Number	:	1598762221
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHRYN A ROACH CRNA

Provider Business Mailing Address
First Line	:	203 SILVERBELL CT
Second Line	:
City	:	WEST CHESTER
State	:	PA
Zip	:	19380-7308
Country	:	US
Telephone Number	:	610-594-5532
Fax Number	:

Provider Business Practice Location Address
First Line	:	111 S 11TH ST
Second Line	:	SUITE 8490
City	:	PHILADELPHIA
State	:	PA
Zip	:	19107-4824
Country	:	US
Telephone Number	:	215-955-6161
Fax Number	:	215-923-5507

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

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	03/13/2015

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