Provider Demographics
NPI:1336279587
Name:CARROCCIA, EUGENE C (MD)
Entity Type:Individual
Prefix:DR
First Name:EUGENE
Middle Name:C
Last Name:CARROCCIA
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 1:8512 VENTNOR AVE
Mailing Address - Street 2:
Mailing Address - City:MARGATE CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:08402-2500
Mailing Address - Country:US
Mailing Address - Phone:609-822-8200
Mailing Address - Fax:609-822-8287
Practice Address - Street 1:8512 VENTNOR AVE
Practice Address - Street 2:
Practice Address - City:MARGATE CITY
Practice Address - State:NJ
Practice Address - Zip Code:08402-2500
Practice Address - Country:US
Practice Address - Phone:609-822-8200
Practice Address - Fax:609-822-8287
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2010-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA29961208200000X, 2082S0099X, 2082S0105X, 2086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No2082S0099XAllopathic & Osteopathic PhysiciansPlastic SurgeryPlastic Surgery Within the Head and Neck
No2082S0105XAllopathic & Osteopathic PhysiciansPlastic SurgerySurgery of the Hand
No2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2894700Medicaid
NJC56146Medicare UPIN
NJ2894700Medicaid