Healthcare Provider Details

I. General information

NPI: 1710163944
Provider Name (Legal Business Name): MICHAEL F LAROCHELLE D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2008
Last Update Date: 04/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 HOSPITAL RD WACHUSETT EMERGENCY PHYSICIANS
LEOMINSTER MA
01453
US

IV. Provider business mailing address

60 HOSPITAL RD WACHUSETT EMERGENCY PHYSICIANS
LEOMINSTER MA
01453
US

V. Phone/Fax

Practice location:
  • Phone: 978-466-2995
  • Fax: 978-466-2993
Mailing address:
  • Phone: 978-466-2995
  • Fax: 978-466-2993

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number00000000000000001
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number235531
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: