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NPI Code Detail

MEDICARE: MARK COCKERILL MD

MEDICARE: MARK COCKERILL MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12085R0202XDiagnostic Radiology Physician0101055902VA
22085R0204XVascular & Interventional Radiology Physician0101055902VA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1033188537
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARK COCKERILL MD
Provider Business Mailing Address
First Line : 110 KINGSLEY LN STE 305
Second Line :
City : NORFOLK
State : VA
Zip : 23505-4617
Country : US
Telephone Number : 757-889-5422
Fax Number : 757-889-5450
Provider Business Practice Location Address
First Line : 150 KINGSLEY LN
Second Line :
City : NORFOLK
State : VA
Zip : 23505-4602
Country : US
Telephone Number : 757-889-5422
Fax Number : 757-889-5450
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/16/2006
Last Update Date : 02/11/2020

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