MEDICARE: RONALD JAY COCCHIARELLA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0205X	Radiological Physics Physician		WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	72001	OTHER	WA	WA LABOR & INDUSTRIES

General Provider Information

NPI Number	:	1255389276
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RONALD JAY COCCHIARELLA MD

Provider Business Mailing Address
First Line	:	801 W 5TH AVENUE
Second Line	:	SUITE 205
City	:	SPOKANE
State	:	WA
Zip	:	99204
Country	:	US
Telephone Number	:	509-747-1187
Fax Number	:	509-747-1180

Provider Business Practice Location Address
First Line	:	801 W 5TH AVENUE
Second Line	:	SUITE 205
City	:	SPOKANE
State	:	WA
Zip	:	99204
Country	:	US
Telephone Number	:	509-747-1187
Fax Number	:	509-747-1180

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/04/2006
Last Update Date	:	07/08/2007

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