Provider Demographics
NPI:1871537688
Name:ROCHE, WALTER J (MD)
Entity type:Individual
Prefix:
First Name:WALTER
Middle Name:J
Last Name:ROCHE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:3333 NORTH CALVERT STREET
Mailing Address - Street 2:SUITE 400
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21218
Mailing Address - Country:US
Mailing Address - Phone:410-554-2270
Mailing Address - Fax:410-261-2726
Practice Address - Street 1:3333 NORTH CALVERT STREET
Practice Address - Street 2:SUITE 400
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21218
Practice Address - Country:US
Practice Address - Phone:410-554-2270
Practice Address - Fax:410-261-2726
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-15
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD053763208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
521892838OtherTAX ID
MD60394904OtherBCBS
MD227000500Medicaid
G32148Medicare UPIN
MD619WMedicare ID - Type Unspecified