Provider Demographics
NPI:1902802523
Name:ROCHESTER, RICHARD EARLE (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:EARLE
Last Name:ROCHESTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5123 VIRGINIA WAY
Mailing Address - Street 2:SUITE C-11
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-7519
Mailing Address - Country:US
Mailing Address - Phone:615-373-5205
Mailing Address - Fax:615-373-5165
Practice Address - Street 1:5123 VIRGINIA WAY
Practice Address - Street 2:SUITE C-11
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-7519
Practice Address - Country:US
Practice Address - Phone:615-373-5205
Practice Address - Fax:615-373-5165
Is Sole Proprietor?:No
Enumeration Date:2005-06-28
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN187822084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3060485Medicare ID - Type UnspecifiedMEDICARE NUMBER
TNE90245Medicare UPIN