Provider Demographics
NPI:1366711293
Name:ROCHA, GABRIEL ARCADIO (PA-C)
Entity type:Individual
Prefix:
First Name:GABRIEL
Middle Name:ARCADIO
Last Name:ROCHA
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10820 BOYKIN PL APT 110
Mailing Address - Street 2:
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28105-8991
Mailing Address - Country:US
Mailing Address - Phone:910-261-7336
Mailing Address - Fax:
Practice Address - Street 1:5801 EXECUTIVE CENTER DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28212-8861
Practice Address - Country:US
Practice Address - Phone:704-863-1550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-21
Last Update Date:2025-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA21284363A00000X
NC0010-04610363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
1090884OtherNCCPA IDENTIFICATION NUMBER
NC1366711293Medicaid
SC1866PAMedicaid
1090884OtherNCCPA IDENTIFICATION NUMBER
NCNCI646AMedicare PIN