Provider Demographics
NPI:1568814077
Name:DELAROCHE, THOMAS ARTHUR (CPO)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:ARTHUR
Last Name:DELAROCHE
Suffix:
Gender:M
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 E ROOSEVELT BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NC
Mailing Address - Zip Code:28112-5170
Mailing Address - Country:US
Mailing Address - Phone:704-291-2218
Mailing Address - Fax:704-291-2241
Practice Address - Street 1:701 E ROOSEVELT BLVD STE B
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28112-5170
Practice Address - Country:US
Practice Address - Phone:704-291-2218
Practice Address - Fax:704-291-2241
Is Sole Proprietor?:No
Enumeration Date:2016-07-08
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
No224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1285631119Medicaid
NC1699053272Medicaid