Provider Demographics
NPI:1831143395
Name:LOEB, ROCHELLE BETH (PA-C)
Entity Type:Individual
Prefix:
First Name:ROCHELLE
Middle Name:BETH
Last Name:LOEB
Suffix:
Gender:F
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 1:43 WHITING HILL RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:BREWER
Mailing Address - State:ME
Mailing Address - Zip Code:04412-1005
Mailing Address - Country:US
Mailing Address - Phone:207-973-5035
Mailing Address - Fax:
Practice Address - Street 1:417 STATE ST
Practice Address - Street 2:SUITE 330
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-6630
Practice Address - Country:US
Practice Address - Phone:207-973-8881
Practice Address - Fax:207-973-8880
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2014-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPA-623363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME047955OtherANTHEM OF MAINE
MEP00197441OtherRAILROAD MEDICARE
ME313040099Medicaid
MEAP0961Medicare PIN
ME047955OtherANTHEM OF MAINE