MEDICARE: REILLY ROCHE

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	363LP2300X	Primary Care Nurse Practitioner	RN2333905	MA

General Provider Information

NPI Number	:	1720938913
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REILLY ROCHE

Provider Business Mailing Address
First Line	:	12 GILBERT DR APT 301
Second Line	:
City	:	MERRIMACK
State	:	NH
Zip	:	03054-2844
Country	:	US
Telephone Number	:	781-424-6861
Fax Number	:

Provider Business Practice Location Address
First Line	:	20 2ND AVE
Second Line	:
City	:	BURLINGTON
State	:	MA
Zip	:	01803-4448
Country	:	US
Telephone Number	:	781-424-6861
Fax Number	:

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

Provider Enumeration Date	:	01/29/2026
Last Update Date	:	01/29/2026

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Directions to “ REILLY ROCHE ” Practice Location

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