Provider Demographics
NPI:1205838885
Name:MARROCCO, GREGORY LEE (MD)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:LEE
Last Name:MARROCCO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6846 MOUNTAIN DRIVE
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:PA
Mailing Address - Zip Code:17331
Mailing Address - Country:US
Mailing Address - Phone:717-632-5931
Mailing Address - Fax:
Practice Address - Street 1:6846 MOUNTAIN DRIVE
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:PA
Practice Address - Zip Code:17331
Practice Address - Country:US
Practice Address - Phone:717-632-5931
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2011-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD029148E2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA20075712OtherAMERIHEALTH MERCY-WMG
PA164858OtherHIGHMARK BLUE SHIELD
PA035186OtherJOHNS HOPKINS
PA50077194OtherCAPITAL BLUE CROSS-WMG
MD151611600Medicaid
PA65753OtherGEISINGER HEALTH PLAN
PA7917571OtherAETNA
PA022343OtherUNISON-WMG
PA0962450Medicaid
PA1509515OtherGATEWAY-WMG
MD919374OtherCAREFIRST MD BCBS
PA50077194OtherCAPITAL BLUE CROSS-WMG
PA1509515OtherGATEWAY-WMG
PA65753OtherGEISINGER HEALTH PLAN