Provider Demographics
NPI:1922087865
Name:ROCHELEAU, LORI R (PA)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:R
Last Name:ROCHELEAU
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 PLANTATION ST
Mailing Address - Street 2:WOT 12TH FLOOR ATTN PHYSICIAN SERVICES
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605
Mailing Address - Country:US
Mailing Address - Phone:508-368-5529
Mailing Address - Fax:508-368-5530
Practice Address - Street 1:191 MAY ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01602
Practice Address - Country:US
Practice Address - Phone:508-368-7888
Practice Address - Fax:508-767-1290
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA285363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
9900376OtherFALLON COMMUNITY HEALTH P
9700112533OtherRAILROAD MEDICARE
AP0274OtherMEDICARE B
83 00400OtherEVERCARE
AP0274OtherBLUE SHIELD INDEMNITY
AP0274OtherBLUE SHIELD INDEMNITY
83 00400OtherEVERCARE