Provider Demographics
NPI:1295940872
Name:ROOCHVARG, LINDA B (MD)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:B
Last Name:ROOCHVARG
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 1:2931 SIMMON TREE RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28270-0660
Mailing Address - Country:US
Mailing Address - Phone:704-845-1040
Mailing Address - Fax:
Practice Address - Street 1:2931 SIMMON TREE RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28270-0660
Practice Address - Country:US
Practice Address - Phone:704-845-1040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9501074208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCD78020Medicare UPIN