Provider Demographics
NPI:1639258353
Name:ROCCO, CARMEN D (MD)
Entity Type:Individual
Prefix:DR
First Name:CARMEN
Middle Name:D
Last Name:ROCCO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 E PRICE RD BLDG F
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78521-3531
Mailing Address - Country:US
Mailing Address - Phone:956-504-6080
Mailing Address - Fax:956-504-6419
Practice Address - Street 1:95 E PRICE RD BLDG F
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78521-3531
Practice Address - Country:US
Practice Address - Phone:956-504-6080
Practice Address - Fax:956-504-6419
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2011-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG3738208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX137218710OtherMEDICAID EPSDT
TX137218707Medicaid
TX137218710OtherMEDICAID EPSDT
TX137218707Medicaid