Provider Demographics
NPI:1225196025
Name:D A ROCHA MD LLC
Entity Type:Organization
Organization Name:D A ROCHA MD LLC
Other - Org Name:CARROLL MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DOMINGO
Authorized Official - Middle Name:ALEXANDER
Authorized Official - Last Name:ROCHA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-374-9391
Mailing Address - Street 1:4231 NORTHWOODS TRAIL
Mailing Address - Street 2:
Mailing Address - City:HAMPSTEAD
Mailing Address - State:MD
Mailing Address - Zip Code:21074
Mailing Address - Country:US
Mailing Address - Phone:410-374-9391
Mailing Address - Fax:410-374-1866
Practice Address - Street 1:4231 NORTHWOODS TRAIL
Practice Address - Street 2:
Practice Address - City:HAMPSTEAD
Practice Address - State:MD
Practice Address - Zip Code:21074
Practice Address - Country:US
Practice Address - Phone:410-374-9391
Practice Address - Fax:410-374-1866
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2008-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD316LMedicare PIN