Provider Demographics
NPI:1942983549
Name:ROCHA, JASON DYLAN (PA-C)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:DYLAN
Last Name:ROCHA
Suffix:
Gender:M
Credentials:PA-C
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Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3857 PECHIN ST UNIT 210
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19128-3642
Mailing Address - Country:US
Mailing Address - Phone:631-560-6045
Mailing Address - Fax:
Practice Address - Street 1:1 BARTOL AVE
Practice Address - Street 2:
Practice Address - City:RIDLEY PARK
Practice Address - State:PA
Practice Address - Zip Code:19078-2214
Practice Address - Country:US
Practice Address - Phone:610-521-8970
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-09
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical