Basic Information
| Provider Information | |||||||||
| NPI: | 1942704994 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LAROCCA | ||||||||
| FirstName: | KRISTINE | ||||||||
| MiddleName: | DEBODA | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 BRAEMORE PL | ||||||||
| Address2: | |||||||||
| City: | WILMINGTON | ||||||||
| State: | DE | ||||||||
| PostalCode: | 198081309 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3028243539 | ||||||||
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| Practice Location | |||||||||
| Address1: | 501 W 14TH ST | ||||||||
| Address2: | |||||||||
| City: | WILMINGTON | ||||||||
| State: | DE | ||||||||
| PostalCode: | 19801 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3024773300 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/22/2018 | ||||||||
| LastUpdateDate: | 07/27/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/27/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | C2-0013617 | DE | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.