Provider Demographics
NPI:1134843030
Name:ROCHA, MANUEL MEDEIROS III
Entity type:Individual
Prefix:
First Name:MANUEL
Middle Name:MEDEIROS
Last Name:ROCHA
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:MANNY
Other - Middle Name:
Other - Last Name:ROCHA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1111 BOYLSTON ST APT 40
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215-3643
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:39 BOWDOIN ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-4201
Practice Address - Country:US
Practice Address - Phone:857-204-6143
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-04
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator