Provider Demographics
NPI:1851344279
Name:LAROCHE, ROGER R (MD)
Entity type:Individual
Prefix:
First Name:ROGER
Middle Name:R
Last Name:LAROCHE
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 1:116 INTERSTATE PKWY
Mailing Address - Street 2:
Mailing Address - City:BRADFORD
Mailing Address - State:PA
Mailing Address - Zip Code:16701-1036
Mailing Address - Country:US
Mailing Address - Phone:814-368-3123
Mailing Address - Fax:
Practice Address - Street 1:777 RAYMOND AVE
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55114-1522
Practice Address - Country:US
Practice Address - Phone:651-447-3755
Practice Address - Fax:651-444-8923
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD046764L2084P0800X
MN321772084A0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Medicine
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0012987900001Medicaid
PA068601D0VMedicare PIN
PAE86576Medicare UPIN