Provider Demographics
NPI:1568415313
Name:ROCHE, MICHAEL JAMES (PA-C)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:JAMES
Last Name:ROCHE
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Gender:M
Credentials:PA-C
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Mailing Address - Street 1:2912 MAPLEWOOD AVE
Mailing Address - Street 2:PREFERRED PAIN MANAGEMENT AND SPINE CARE P.A.
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-4010
Mailing Address - Country:US
Mailing Address - Phone:336-760-0706
Mailing Address - Fax:336-499-4778
Practice Address - Street 1:1511 WESTOVER TERRACE SUITE 107
Practice Address - Street 2:PREFERRED PAIN MANAGEMENT AND SPINE CARE P.A.
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408-7128
Practice Address - Country:US
Practice Address - Phone:336-398-5155
Practice Address - Fax:336-398-5153
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2017-04-24
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Provider Licenses
StateLicense IDTaxonomies
NC0010-06005363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHROPA26851Medicare UPIN
OH50002456OtherSTATE MEDICAL LICENSE