MEDICARE: MR. ROBERT ALLAN ROCHE-BARNETT MD

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	207R00000X	Internal Medicine Physician	176130-1	NY

General Provider Information

NPI Number	:	1881695500
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ROBERT ALLAN ROCHE-BARNETT MD

Provider Business Mailing Address
First Line	:	581 MIDDLE RD
Second Line	:
City	:	BAYPORT
State	:	NY
Zip	:	11705-1916
Country	:	US
Telephone Number	:	631-472-8100
Fax Number	:	631-472-8811

Provider Business Practice Location Address
First Line	:	581 MIDDLE RD
Second Line	:
City	:	BAYPORT
State	:	NY
Zip	:	11705-1916
Country	:	US
Telephone Number	:	631-472-8100
Fax Number	:	631-472-8811

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

Provider Enumeration Date	:	08/03/2005
Last Update Date	:	11/17/2009

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