Provider Demographics
NPI:1184604472
Name:ROCHE, JENNIFER M (MD)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:M
Last Name:ROCHE
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:31 HALL DR
Mailing Address - Street 2:SUITE 2
Mailing Address - City:AMHERST
Mailing Address - State:MA
Mailing Address - Zip Code:01002-2751
Mailing Address - Country:US
Mailing Address - Phone:413-253-3773
Mailing Address - Fax:413-256-0215
Practice Address - Street 1:31 HALL DR
Practice Address - Street 2:SUITE 2
Practice Address - City:AMHERST
Practice Address - State:MA
Practice Address - Zip Code:01002-2751
Practice Address - Country:US
Practice Address - Phone:413-253-3773
Practice Address - Fax:413-256-0215
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-20
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA207832208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ22817OtherBLUE CROSS AND BLUE SHIEL
MA207832OtherCONNECTICARE
MA2375366OtherAETNA
MA26941OtherHEALTH NEW ENGLAND
MA0110990Medicaid
MA0000000013337OtherBMC HEALTHNET
MA207832OtherTUFTS HEALTH PLAN
MA202323OtherHARVARD PILGRIM HEALTH CA
MA2375366OtherAETNA