Provider Demographics
NPI:1205857190
Name:CRESCENZO, ROCCO J (DO)
Entity Type:Individual
Prefix:
First Name:ROCCO
Middle Name:J
Last Name:CRESCENZO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 AMBER CIR
Mailing Address - Street 2:
Mailing Address - City:NORRISTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19401-1839
Mailing Address - Country:US
Mailing Address - Phone:610-539-5373
Mailing Address - Fax:610-539-8260
Practice Address - Street 1:531 W GERMANTOWN PIKE
Practice Address - Street 2:STE 101
Practice Address - City:PLYMOUTH MEETING
Practice Address - State:PA
Practice Address - Zip Code:19462-1325
Practice Address - Country:US
Practice Address - Phone:610-539-5373
Practice Address - Fax:610-539-8260
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-23
Last Update Date:2016-05-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAOS008171L207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018732750002Medicaid
PA820749Medicare ID - Type Unspecified
PAG19803Medicare UPIN