| Edmund J Roache Md | |
|
200 Mullin Street Suite 201 Watertown NY 13601 | |
| (315) 785-8591 | |
| (315) 785-8591 |
| Full Name | Edmund J Roache Md |
|---|---|
| Speciality | Internal Medicine |
| Location | 200 Mullin Street, Watertown, New York |
| Authorized Official Name and Position | Edmund J Roache (OWNER) |
| Authorized Official Contact | 3157824475 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Edmund J Roache Md 200 Mullin Street Suite 201 Watertown NY 13601 Ph: (315) 785-8591 | Edmund J Roache Md 200 Mullin Street Suite 201 Watertown NY 13601 Ph: (315) 785-8591 |
| NPI Number | 1245265321 |
|---|---|
| Provider Enumeration Date | 07/11/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1245265321 | NPI | - | NPPES |
| 00772743 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 153941 (New York) | Primary |
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