Provider Demographics
NPI:1023040813
Name:DAROCHA, ..IRENE B (MD)
Entity Type:Individual
Prefix:
First Name:..IRENE
Middle Name:B
Last Name:DAROCHA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 537
Mailing Address - Street 2:
Mailing Address - City:WESTTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19395-0537
Mailing Address - Country:US
Mailing Address - Phone:610-999-0780
Mailing Address - Fax:
Practice Address - Street 1:1210 PAGE TER
Practice Address - Street 2:
Practice Address - City:VILLANOVA
Practice Address - State:PA
Practice Address - Zip Code:19085-2132
Practice Address - Country:US
Practice Address - Phone:610-526-9942
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD039408E174400000X, 2085R0202X
MDD00576762085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0509987000OtherKEYSTONE HMO
PADA676496OtherBCBS
MD61379901OtherBLUE CROSS/BLUE SHIELD MD
MD766702700Medicaid
PA0143630411Medicaid
PA300103158OtherRAILROAD MEDICARE
MD300129623OtherRAILROAD MEDICARE
PA01436304Medicaid
PA1115837OtherKEYSTONE HEALTH PLAN
PA0014363040010Medicaid
MDE89145OtherTRICARE
MD1190944605OtherOWCP
PA3977180OtherAETNA
MDE89145OtherTRICARE
PADA676496OtherBCBS
MD61379901OtherBLUE CROSS/BLUE SHIELD MD
MD766702700Medicaid
PA0014363040010Medicaid