Individual
EDMUND J ROACHE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
200 MULLIN ST, WATERTOWN, NY 13601-3619
(315) 785-8591
(315) 782-4475
Mailing address
200 MULLIN ST, #102, WATERTOWN, NY 13601-3619
(315) 782-4475
(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
05/17/2006
Last updated
08/03/2015
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