Provider Demographics
NPI:1760485320
Name:LAROCHELLE, ANNE GHISLAINE (MD)
Entity Type:Individual
Prefix:DR
First Name:ANNE
Middle Name:GHISLAINE
Last Name:LAROCHELLE
Suffix:
Gender:F
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:PO BOX 3439
Mailing Address - Street 2:
Mailing Address - City:NORTH MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29582-0439
Mailing Address - Country:US
Mailing Address - Phone:843-839-4447
Mailing Address - Fax:843-399-0123
Practice Address - Street 1:945 82ND PKWY
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29572-4612
Practice Address - Country:US
Practice Address - Phone:843-497-5929
Practice Address - Fax:843-839-6375
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD044827E207RE0101X
SC38787207RE0101X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0012091730003Medicaid
PA607170Medicare PIN
E68891Medicare UPIN
PA4235190002Medicare NSC
PAE68891OtherHEALTH AMERICA
PA607170Medicare PIN
E68891Medicare UPIN
PA0012091730003Medicaid
PA4235190002Medicare NSC
PA6567860OtherCIGNA
PA1555144OtherGATEWAY HEALTH PLAN
PA4235190001Medicare NSC