Provider Demographics
NPI:1508957952
Name:ROCCO, CHRISTOPHER P (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:P
Last Name:ROCCO
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 1:1210 MEDICAL ARTS BLVD STE 114
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:IN
Mailing Address - Zip Code:46011-3442
Mailing Address - Country:US
Mailing Address - Phone:765-298-4545
Mailing Address - Fax:765-298-4545
Practice Address - Street 1:1210 MEDICAL ARTS BLVD STE 114
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:IN
Practice Address - Zip Code:46011-3442
Practice Address - Country:US
Practice Address - Phone:765-298-4545
Practice Address - Fax:765-298-4545
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2019-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01039888A2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100368460AMedicaid
IN000000086593OtherANTHEM BLUE CROSS BLUE SH
130008157OtherRAILROAD MEDICARE
IN000000086593OtherANTHEM BLUE CROSS BLUE SH
E85748Medicare UPIN
IN716700005Medicare PIN