Provider Demographics
NPI:1477714442
Name:ROA, DESIREE LYNN (MD)
Entity Type:Individual
Prefix:DR
First Name:DESIREE
Middle Name:LYNN
Last Name:ROA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10820 PARKSIDE DR
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37934-1956
Mailing Address - Country:US
Mailing Address - Phone:865-218-7972
Mailing Address - Fax:865-218-7973
Practice Address - Street 1:2305 N GATEWAY AVE
Practice Address - Street 2:
Practice Address - City:HARRIMAN
Practice Address - State:TN
Practice Address - Zip Code:37748-8665
Practice Address - Country:US
Practice Address - Phone:800-805-6989
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-22
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD47725208M00000X
TNMD0000047725207R00000X
TN47725207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN103I113778Medicare PIN