Provider Demographics
NPI:1700609799
Name:ROLDAN, BENJAMIN MANUEL
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:MANUEL
Last Name:ROLDAN
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:BEE
Other - Middle Name:MANUEL
Other - Last Name:ROLDAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:207 SHAWSHEEN RD
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01810-2978
Mailing Address - Country:US
Mailing Address - Phone:978-242-4002
Mailing Address - Fax:
Practice Address - Street 1:207 SHAWSHEEN RD
Practice Address - Street 2:
Practice Address - City:ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01810-2978
Practice Address - Country:US
Practice Address - Phone:978-242-4002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-06
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula