MEDICARE: JOHN A. ROCHE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	C003489	NC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2342249	OTHER	NC	GROUP MEDICARE

General Provider Information

NPI Number	:	1518901735
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN A. ROCHE

Provider Business Mailing Address
First Line	:	2443 SAGVARO LANE
Second Line	:
City	:	KANNAPOLIS
State	:	NC
Zip	:	28083
Country	:	US
Telephone Number	:	704-932-9384
Fax Number	:

Provider Business Practice Location Address
First Line	:	1309 SOUTH CANNON BLVD
Second Line	:
City	:	KANNAPOLIS
State	:	NC
Zip	:	28083
Country	:	US
Telephone Number	:	704-933-3212
Fax Number	:	704-933-3221

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/16/2006
Last Update Date	:	07/08/2007

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