PHILIP M. ROACH PA (Credential# 952692) is licensed (Physician Assistant) with Connecticut Department of Consumer Protection. The license effective date is March 1, 2020. The license expiration date date is February 28, 2021. The license status is ACTIVE.
PHILIP M. ROACH PA is licensed with the Department of Consumer Protection of Connecticut. The credential number is #23.002469. The credential type is physician assistant. The effective date is March 1, 2020. The expiration date is February 28, 2021. The business address is 3 David Dr, Simsbury, CT 06070-3043. The current status is active.
| Licensee Name | PHILIP M. ROACH PA |
| Credential ID | 952692 |
| Credential Number | 23.002469 |
| Credential Type | Physician Assistant |
| Business Address |
3 David Dr Simsbury CT 06070-3043 |
| Business Type | INDIVIDUAL |
| Status | ACTIVE - CURRENT |
| Active | 1 |
| Issue Date | 2010-09-15 |
| Effective Date | 2020-03-01 |
| Expiration Date | 2021-02-28 |
| Refresh Date | 2020-01-09 |
| ID | Credential Code | Credential Type | Issue | Term | Status |
|---|---|---|---|---|---|
| 968888 | CSP.0049060 | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER | 2010-10-06 | 2019-03-01 - 2021-02-28 | ACTIVE |
| 847291 | 70.007558 | Emergency Medical Technician | 2006-07-31 | 2006-07-31 - 2008-03-31 | INACTIVE |
| Street Address | 3 DAVID DR |
| City | SIMSBURY |
| State | CT |
| Zip Code | 06070-3043 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Elizabeth A Ross | 7 David Dr, Simsbury, CT 06070-3043 | Registered Nurse | 2020-04-01 ~ 2021-03-31 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Henry Withers | 571 Hopmeadow St, Simsbury, CT 06070 | Landscape Architect | 2020-08-01 ~ 2021-07-31 |
| Nancy W Flanagan | 9 Carver Circle, Simsbury, CT 06070 | Real Estate Salesperson | 2020-06-23 ~ 2021-05-31 |
| Catharina A Bates | 12 East View Dr., Simsbury, CT 06070 | Real Estate Salesperson | 2020-06-25 ~ 2021-05-31 |
| Faith E Preato | 25 Squadron Line Rd, Simsbury, CT 06070 | Registered Nurse | 2020-07-01 ~ 2021-06-30 |
| Diane Bragoni | 542 Hopmeadow Street, #128, Simsbury, CT 06070 | Architect | 2020-08-01 ~ 2021-07-31 |
| Virginia S Durst · Banks | 20 Woodcliff Drive, Simsbury, CT 06070 | Registered Nurse | 2020-05-01 ~ 2021-04-30 |
| Caitlin M Cornier | 18 Saxton Brook Drive, Simsbury, CT 06070 | Registered Nurse | 2020-07-01 ~ 2021-06-30 |
| Nancy L Alleva · Maule | 1079 Hopmeadow St, Simsbury, CT 06070 | Respiratory Care Practitioner | 2020-09-01 ~ 2021-08-31 |
| Stephen R Birghenti · Simsbury Inn | 397 Hopmeadow St, Simsbury, CT 06070 | Hotel Liquor (50000 Or More Population) | 2019-08-14 ~ 2020-12-13 |
| Deborah L Poniatowski · Blase | 35 Munnisunk Dr, Simsbury, CT 06070 | Registered Nurse | 2020-08-01 ~ 2021-07-31 |
| Find all Licenses in zip 06070 | |||
| City | SIMSBURY |
| Zip Code | 06070 |
| License Type | Physician Assistant |
| License Type + County | Physician Assistant + SIMSBURY |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Katie M Roach | 3 David Drive, Simsbury, CT 06070 | Physician Assistant | 2020-06-01 ~ 2021-05-31 |
| Lawrence Flynn Pa | 23 Philip Dr, Storrs, CT 06268 | Physician Assistant | 2007-01-23 ~ 2008-03-31 |
| Philip J Bergen | 4 Sky Edge Ln, Bethel, CT 06801-1023 | Physician Assistant | 2020-06-03 ~ 2021-03-31 |
| Jayson Philip Richter | 419 West Shore Rd., Otis, ME 04605 | Physician Assistant | ~ |
| Brandon Philip Lombardo | 301 Vilna Rd, Pittston, PA 18640 | Physician Assistant | 2017-10-04 ~ 2018-05-31 |
| Philip Samuel Black | 1020 Oak St, Coatesville, PA 19320-3830 | Physician Assistant | 2020-04-01 ~ 2021-03-31 |
| Philip K Nelson | C/o Noss--500 Chase Parkway, Waterbury, CT 06708-3346 | Physician Assistant | 2020-09-01 ~ 2021-08-31 |
| Shiva L Kashanipour | One King Philip Drive, West Hartford, CT 06117 | Physician Assistant | 2008-05-12 ~ 2009-04-30 |
| Kelly J Roach | 13 Wildflower Dr, Seekonk, MA 02771-1703 | Physical Therapist Assistant | 2019-12-01 ~ 2020-11-30 |
| Brian John Roach | 50 Eastern Pkwy, Milford, CT 06460-5001 | Physical Therapist Assistant | 2020-01-01 ~ 2020-12-31 |
Please comment or provide details below to improve the information on PHILIP M. ROACH PA.
| Data Provider | Connecticut Department of Consumer Protection |
| Jurisdiction | Connecticut |
| Related Datasets | Connecticut Business Registrations, Connecticut Child Care Facilities |
This dataset includes 1.41 million licenses issued wtih Connecticut Department of Consumer Protection (TDLR).