Provider Demographics
NPI:1073962338
Name:COCCO, CARLO
Entity Type:Individual
Prefix:
First Name:CARLO
Middle Name:
Last Name:COCCO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2534 EMPIRE DR
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-6710
Mailing Address - Country:US
Mailing Address - Phone:336-397-2165
Mailing Address - Fax:
Practice Address - Street 1:16 INDUSTRIAL BLVD
Practice Address - Street 2:STE 101
Practice Address - City:PAOLI
Practice Address - State:PA
Practice Address - Zip Code:19301-1609
Practice Address - Country:US
Practice Address - Phone:610-644-2589
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-08
Last Update Date:2016-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist