Provider Demographics
NPI:1376707281
Name:JOSEPH A. COCCO DO, PA
Entity Type:Organization
Organization Name:JOSEPH A. COCCO DO, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLAIMS SPECIALIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:TINA
Authorized Official - Middle Name:LYNNETTE
Authorized Official - Last Name:LEWELLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-517-9369
Mailing Address - Street 1:5801 OAKBEND TRL
Mailing Address - Street 2:STE. 270
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76132-3912
Mailing Address - Country:US
Mailing Address - Phone:817-263-6660
Mailing Address - Fax:
Practice Address - Street 1:5801 OAKBEND TRL
Practice Address - Street 2:STE. 270
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-3912
Practice Address - Country:US
Practice Address - Phone:817-263-6660
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-10
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL4308208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00959TMedicare PIN