Healthcare Provider Details

I. General information

NPI: 1477085629
Provider Name (Legal Business Name): ABBEY ROCCO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ABBEY MICHELLE ROCCO MD

II. Dates (important events)

Enumeration Date: 03/28/2017
Last Update Date: 07/23/2024
Certification Date: 07/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

WUSM PEDS, 1 CHILDRENS PL MSC 8116-0043-09
SAINT LOUIS MO
63110
US

IV. Provider business mailing address

1465 S GRAND BLVD
SAINT LOUIS MO
63104-1003
US

V. Phone/Fax

Practice location:
  • Phone: 314-454-6018
  • Fax: 844-621-4392
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2023031195
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License Number2023031195
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: