Provider Demographics
NPI:1396380416
Name:BOCCIA, AMY JOANN (MAC)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:JOANN
Last Name:BOCCIA
Suffix:
Gender:F
Credentials:MAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1086 LILLYGATE LN
Mailing Address - Street 2:
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21014-2706
Mailing Address - Country:US
Mailing Address - Phone:443-253-6025
Mailing Address - Fax:
Practice Address - Street 1:1086 LILLYGATE LN
Practice Address - Street 2:
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014-2706
Practice Address - Country:US
Practice Address - Phone:443-253-6025
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-13
Last Update Date:2019-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU00864171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist