Provider Demographics
NPI:1659695526
Name:ROACH, LINDSAY E (DO)
Entity Type:Individual
Prefix:
First Name:LINDSAY
Middle Name:E
Last Name:ROACH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:224D CORNWALL STREET NW
Mailing Address - Street 2:SUITE 403
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20176-2704
Mailing Address - Country:US
Mailing Address - Phone:703-737-6001
Mailing Address - Fax:703-443-8643
Practice Address - Street 1:19500 SANDRIDGE WAY
Practice Address - Street 2:SUITE 110
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-6821
Practice Address - Country:US
Practice Address - Phone:703-723-7337
Practice Address - Fax:703-723-8278
Is Sole Proprietor?:No
Enumeration Date:2010-03-22
Last Update Date:2023-10-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0102206599208D00000X, 208000000X
NE881208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1659695526Medicaid
VA30016583650001Medicaid