Provider Demographics
NPI:1023700507
Name:ROACH, ALYSSA MARGUERITE (CNM)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:MARGUERITE
Last Name:ROACH
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:ALYSSA
Other - Middle Name:MARGUERITE
Other - Last Name:ROACH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CNM
Mailing Address - Street 1:631 LEVERINGTON AVE APT 108
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19128-2608
Mailing Address - Country:US
Mailing Address - Phone:484-274-9819
Mailing Address - Fax:
Practice Address - Street 1:123 FRANKLIN CORNER RD STE 214
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08648-2526
Practice Address - Country:US
Practice Address - Phone:484-274-9819
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-23
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife