Provider Demographics
NPI:1467430280
Name:LAROCCO, BRIAN G (MD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:G
Last Name:LAROCCO
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 1:1701 TWIN SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:HALETHORPE
Mailing Address - State:MD
Mailing Address - Zip Code:21227-3553
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1701 TWIN SPRINGS RD
Practice Address - Street 2:
Practice Address - City:HALETHORPE
Practice Address - State:MD
Practice Address - Zip Code:21227-3553
Practice Address - Country:US
Practice Address - Phone:703-359-7878
Practice Address - Fax:302-224-2848
Is Sole Proprietor?:No
Enumeration Date:2006-01-03
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC10007463207P00000X
MDD0063337207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD408075100Medicaid
MD413046400Medicaid
DE10000035055Medicaid
MD161MP678Medicare PIN
I24711Medicare UPIN
DE016019 D04Medicare ID - Type Unspecified
MD489PR156Medicare PIN
MD413046400Medicaid
MDKS17P537Medicare PIN
MDR156Medicare PIN
MDI24711Medicare UPIN