Provider Demographics
NPI:1700179587
Name:ROE, DANIELLE ALEXIS (MD)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:ALEXIS
Last Name:ROE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 JEFFERSON AVE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:JEANNETTE
Mailing Address - State:PA
Mailing Address - Zip Code:15644-2538
Mailing Address - Country:US
Mailing Address - Phone:724-850-6933
Mailing Address - Fax:724-522-4002
Practice Address - Street 1:56 CLUB LN
Practice Address - Street 2:STE 102
Practice Address - City:BLAIRSVILLE
Practice Address - State:PA
Practice Address - Zip Code:15717-7957
Practice Address - Country:US
Practice Address - Phone:724-459-5203
Practice Address - Fax:724-459-0949
Is Sole Proprietor?:No
Enumeration Date:2011-05-26
Last Update Date:2017-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD451069207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1029887530004Medicaid
PA384530Medicare PIN