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Organization

EDMUND J ROACHE MD

Active
Organization subpart
No

Provider details

NPI number
Authorized official
EDMUND J ROACHE MD (OWNER)
(315) 782-4475
Entity
Organization

Contact information

Practice address
200 MULLIN STREET, SUITE 201, WATERTOWN, NY 13601
(315) 785-8591
(315) 785-8591
Mailing address
200 MULLIN STREET, SUITE 201, WATERTOWN, NY 13601
(315) 785-8591
(315) 785-8591

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
153941
NY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
00772743
NY
Enumeration date
07/11/2006
Last updated
08/22/2020
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