Healthcare Provider Details

I. General information

NPI: 1386175727
Provider Name (Legal Business Name): WILLIAM K ROACHE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2017
Last Update Date: 01/12/2024
Certification Date: 01/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

171 KEMPSVILLE RD BLDG A
NORFOLK VA
23502-4700
US

IV. Provider business mailing address

171 KEMPSVILLE RD BLDG A
NORFOLK VA
23502-4700
US

V. Phone/Fax

Practice location:
  • Phone: 757-668-6550
  • Fax:
Mailing address:
  • Phone: 757-668-6550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number294910
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number294910
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number0101281004
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: