Provider Demographics
NPI:1437262854
Name:RADNOR PSYCHIATRIC GROUP
Entity Type:Organization
Organization Name:RADNOR PSYCHIATRIC GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:EARLE
Authorized Official - Last Name:ROCHESTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:615-373-5205
Mailing Address - Street 1:5123 VIRGINIA WAY
Mailing Address - Street 2:SUITE C-11
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-7519
Mailing Address - Country:US
Mailing Address - Phone:615-373-5205
Mailing Address - Fax:615-373-5165
Practice Address - Street 1:5123 VIRGINIA WAY
Practice Address - Street 2:SUITE C-11
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-7519
Practice Address - Country:US
Practice Address - Phone:615-373-5205
Practice Address - Fax:615-373-5165
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-17
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN187822084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty