Provider Demographics
NPI:1225170806
Name:LA ROCCO, GEORGE EDWARD (MD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:EDWARD
Last Name:LA ROCCO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 20285
Mailing Address - Street 2:
Mailing Address - City:TOWESON
Mailing Address - State:MD
Mailing Address - Zip Code:21284-0285
Mailing Address - Country:US
Mailing Address - Phone:410-765-6214
Mailing Address - Fax:410-981-4764
Practice Address - Street 1:7323 AVIATION BLVD MS 1178
Practice Address - Street 2:
Practice Address - City:LINTHICUM
Practice Address - State:MD
Practice Address - Zip Code:21090
Practice Address - Country:US
Practice Address - Phone:410-765-6214
Practice Address - Fax:410-981-4764
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD16006207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
B69585Medicare UPIN
P615Medicare ID - Type Unspecified