Provider Demographics
NPI:1083725964
Name:ROCKACY, JEFFREY W (DMD, MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:W
Last Name:ROCKACY
Suffix:
Gender:M
Credentials:DMD, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 16008
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15242
Mailing Address - Country:US
Mailing Address - Phone:412-920-5860
Mailing Address - Fax:
Practice Address - Street 1:101 FOWLER RD
Practice Address - Street 2:STE A
Practice Address - City:WARRENDALE
Practice Address - State:PA
Practice Address - Zip Code:15086-1114
Practice Address - Country:US
Practice Address - Phone:412-920-5860
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2019-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS041793122300000X
PAMD465831204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5N371OtherBCBS MEDICAL
I11919Medicare UPIN
AR5Y500Medicare ID - Type Unspecified
AR5Y500Medicare PIN