Provider Demographics
NPI:1396745089
Name:ROACH, HARRY ALLEN (MD)
Entity type:Individual
Prefix:DR
First Name:HARRY
Middle Name:ALLEN
Last Name:ROACH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4228 HOUMA BLVD STE 130
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70006-3003
Mailing Address - Country:US
Mailing Address - Phone:504-454-2222
Mailing Address - Fax:504-454-2388
Practice Address - Street 1:4228 HOUMA BLVD STE 130
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-3003
Practice Address - Country:US
Practice Address - Phone:504-454-2222
Practice Address - Fax:504-454-2388
Is Sole Proprietor?:No
Enumeration Date:2005-07-26
Last Update Date:2019-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA015840208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1370177Medicaid
LA53028Medicare ID - Type Unspecified
B89587Medicare UPIN