Healthcare Provider Details

I. General information

NPI: 1629077789
Provider Name (Legal Business Name): ALFRED COCCARO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2005
Last Update Date: 11/01/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 VARNUM ST NE
WASHINGTON DC
20017-2180
US

IV. Provider business mailing address

4700 BERWYN HOUSE RD STE 208
COLLEGE PARK MD
20740-2474
US

V. Phone/Fax

Practice location:
  • Phone: 202-269-7000
  • Fax:
Mailing address:
  • Phone: 301-220-0150
  • Fax: 301-220-1032

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberD0014031
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number0101022473
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD6699
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: