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General NPI Number Information
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NPI Number | 1437170370
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Entity Type | Individual
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Provider Name | PAUL M LAROCQUE PA
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Gender | Male
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Dates
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Enumeration Date | 07/23/2006
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Last Update Date | 08/28/2020
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Provider Practice Location Address
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Address Line | 1900 RANDOLPH RD STE 900
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City | CHARLOTTE
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State | NC
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Zip | 28207-1122
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Country | US
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Telephone | 704-377-2424
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Fax | 704-377-2687
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Provider Business Mailing Address
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Address Line | 1290 SILAS DEANE HWY HHC CVO ENROLLMENT 1ST FLOOR
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City | WETHERSFIELD
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State | CT
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Zip | 06109-4337
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Country | US
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Telephone | 860-972-6970
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 00181
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License Number State | CT
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