Healthcare Provider Details

I. General information

NPI: 1881663284
Provider Name (Legal Business Name): RALPH V BOCCIA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2006
Last Update Date: 01/03/2023
Certification Date: 01/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6410 ROCKLEDGE DR SUITE 660
BETHESDA MD
20817-1809
US

IV. Provider business mailing address

PO BOX 749488
ATLANTA GA
30374-9488
US

V. Phone/Fax

Practice location:
  • Phone: 301-571-0019
  • Fax: 301-571-0988
Mailing address:
  • Phone: 239-432-8331
  • Fax: 813-321-1296

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberD29675
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberD29675
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: