MEDICARE: THOMAS ROBERT ROCCO 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
1	208600000X	Surgery Physician	MD09898	RI

Other Identifiers

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

General Provider Information

NPI Number	:	1326016528
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOMAS ROBERT ROCCO MD

Provider Business Mailing Address
First Line	:	6 BLACKSTONE VALLEY PL STE 706
Second Line	:
City	:	LINCOLN
State	:	RI
Zip	:	02865-1170
Country	:	US
Telephone Number	:	401-334-9630
Fax Number	:	401-334-0563

Provider Business Practice Location Address
First Line	:	1526 ATWOOD AVE STE 200
Second Line	:
City	:	JOHNSTON
State	:	RI
Zip	:	02919-3289
Country	:	US
Telephone Number	:	401-404-2975
Fax Number	:	401-404-2976

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/14/2006
Last Update Date	:	10/04/2019

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