Healthcare Provider Details

I. General information

NPI: 1760745087
Provider Name (Legal Business Name): DEANNA B. TOCCO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2012
Last Update Date: 03/20/2020
Certification Date: 03/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2207 BOSTON ROAD
WILBRAHAM MA
01095
US

IV. Provider business mailing address

2207 BOSTON ROAD
WILBRAHAM MA
01095
US

V. Phone/Fax

Practice location:
  • Phone: 413-599-1201
  • Fax: 413-596-2940
Mailing address:
  • Phone: 413-599-1201
  • Fax: 413-596-2940

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMT201281
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD454595
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number57172
License Number StateCT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: