Healthcare Provider Details

I. General information

NPI: 1073597530
Provider Name (Legal Business Name): ELIZABETH GRACE ROCCO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2005
Last Update Date: 03/14/2025
Certification Date: 03/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 BINNEY ST
CAMBRIDGE MA
02142-1096
US

IV. Provider business mailing address

73D WINTHROP AVE PLAZA 114
LAWRENCE MA
01843-3716
US

V. Phone/Fax

Practice location:
  • Phone: 888-663-6331
  • Fax: 415-252-7176
Mailing address:
  • Phone: 978-686-3017
  • Fax: 978-685-4280

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number219675
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: