Healthcare Provider Details

I. General information

NPI: 1972594091
Provider Name (Legal Business Name): JAMES W. ROCCO M.D.,PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2005
Last Update Date: 12/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 OLENTANGY RIVER RD
COLUMBUS OH
43212-3153
US

IV. Provider business mailing address

915 OLENTANGY RIVER RD
COLUMBUS OH
43212-3153
US

V. Phone/Fax

Practice location:
  • Phone: 614-366-3687
  • Fax: 614-293-7292
Mailing address:
  • Phone: 614-366-3687
  • Fax: 614-293-7292

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207YX0007X
TaxonomyPlastic Surgery within the Head & Neck (Otolaryngology) Physician
License Number161152
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number35125186
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: