Healthcare Provider Details

I. General information

NPI: 1992763635
Provider Name (Legal Business Name): ROCCO G CIOCCA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 02/08/2021
Certification Date: 02/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 W PUTNAM AVE STE 350
GREENWICH CT
06830-6086
US

IV. Provider business mailing address

5 PERRYRIDGE RD
GREENWICH CT
06830-4608
US

V. Phone/Fax

Practice location:
  • Phone: 203-863-4210
  • Fax:
Mailing address:
  • Phone: 203-863-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number67304
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: