Provider Demographics
NPI:1306837091
Name:ROCCHI, JOHN R (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:R
Last Name:ROCCHI
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 1:480 E JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:BUTLER
Mailing Address - State:PA
Mailing Address - Zip Code:16001-4780
Mailing Address - Country:US
Mailing Address - Phone:724-282-4504
Mailing Address - Fax:724-431-4725
Practice Address - Street 1:480 E JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:BUTLER
Practice Address - State:PA
Practice Address - Zip Code:16001-4780
Practice Address - Country:US
Practice Address - Phone:724-282-4504
Practice Address - Fax:724-431-4725
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2009-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD06091L207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAR0900890Medicaid
PAR0900890Medicaid
688070Medicare ID - Type Unspecified
PA900890KHVMedicare PIN