MEDICARE: DR. SANDRO LAROCCA M.D.

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	174400000X	Specialist	25MA07275400	NJ
2	174400000X	Specialist	MD063167L	PA

General Provider Information

NPI Number	:	1548267628
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SANDRO LAROCCA M.D.

Provider Business Mailing Address
First Line	:	3131 PRINCETON PIKE
Second Line	:	BUILDING 6, SUITE 106
City	:	LAWRENCEVILLE
State	:	NJ
Zip	:	08648-2201
Country	:	US
Telephone Number	:	609-896-0020
Fax Number	:	609-896-0041

Provider Business Practice Location Address
First Line	:	3131 PRINCETON PIKE
Second Line	:	BUILDING 6, SUITE 106
City	:	LAWRENCEVILLE
State	:	NJ
Zip	:	08648-2201
Country	:	US
Telephone Number	:	609-896-0020
Fax Number	:	609-896-0041

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

Provider Enumeration Date	:	07/05/2005
Last Update Date	:	09/24/2010

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