Provider Demographics
NPI:1386655710
Name:ROCHA, ANTHONY V (MD)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:V
Last Name:ROCHA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:387 WATERMAN AVE
Mailing Address - Street 2:
Mailing Address - City:EAST PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02914-2618
Mailing Address - Country:US
Mailing Address - Phone:401-438-2780
Mailing Address - Fax:401-438-4763
Practice Address - Street 1:387 WATERMAN AVE
Practice Address - Street 2:
Practice Address - City:EAST PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02914-2618
Practice Address - Country:US
Practice Address - Phone:401-438-2780
Practice Address - Fax:401-438-4763
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD05196207Q00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIAR31378Medicaid
C90263Medicare UPIN