Healthcare Provider Details

I. General information

NPI: 1326016528
Provider Name (Legal Business Name): THOMAS ROBERT ROCCO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 10/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1526 ATWOOD AVE STE 200
JOHNSTON RI
02919-3289
US

IV. Provider business mailing address

6 BLACKSTONE VALLEY PL STE 706
LINCOLN RI
02865-1170
US

V. Phone/Fax

Practice location:
  • Phone: 401-404-2975
  • Fax: 401-404-2976
Mailing address:
  • Phone: 401-334-9630
  • Fax: 401-334-0563

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD09898
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: