Provider Demographics
NPI:1831178631
Name:LAROCQUE, JOCELYN H (DO)
Entity type:Individual
Prefix:DR
First Name:JOCELYN
Middle Name:H
Last Name:LAROCQUE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:15830 BALLANTYNE MEDICAL PL
Mailing Address - Street 2:STE 100
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-4653
Mailing Address - Country:US
Mailing Address - Phone:704-341-0090
Mailing Address - Fax:704-341-0092
Practice Address - Street 1:15830 BALLANTYNE MEDICAL PL
Practice Address - Street 2:STE 100
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-4653
Practice Address - Country:US
Practice Address - Phone:704-341-0090
Practice Address - Fax:704-341-0092
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2015-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2005-00628207N00000X
NC200500628207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCP0031039OtherMEDICARE RAILROAD
NC5903749Medicaid
NC5903749Medicaid
NCI49267Medicare UPIN