Provider Demographics
NPI:1356324917
Name:LARICE, ROLANDO A (MD)
Entity type:Individual
Prefix:DR
First Name:ROLANDO
Middle Name:A
Last Name:LARICE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:140 CHESTERFIELD COMMONS RD E
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63005-1440
Mailing Address - Country:US
Mailing Address - Phone:314-434-9181
Mailing Address - Fax:314-569-2280
Practice Address - Street 1:140 CHESTERFIELD COMMONS RD E
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63005-1440
Practice Address - Country:US
Practice Address - Phone:314-434-9181
Practice Address - Fax:636-536-9588
Is Sole Proprietor?:No
Enumeration Date:2005-11-28
Last Update Date:2020-03-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO1165172084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO203861919Medicaid
MO000094584Medicare ID - Type Unspecified
E77391Medicare UPIN