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General NPI Number Information
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NPI Number | 1568921302
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Entity Type | Individual
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Provider Name | RYAN LAROCHELLE M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/19/2019
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Last Update Date | 09/15/2025
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Provider Practice Location Address
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Address Line | 15 LOWELL ST
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City | PORTLAND
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State | ME
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Zip | 04102-2792
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Country | US
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Telephone | 207-774-8277
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Fax |
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Provider Business Mailing Address
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Address Line | 2 OAK GLEN CT
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City | MADISON
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State | WI
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Zip | 53717-1605
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Country | US
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Telephone | 207-852-1441
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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 | 207WX0200X
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Taxonomy Name | Ophthalmic Plastic and Reconstructive Surgery Physician
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License Number | 81645
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | MD28531
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License Number State | ME
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Taxonomy #3
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 81645
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License Number State | WI
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Taxonomy #4
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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