Provider Demographics
NPI:1881632172
Name:COCOZZELLA, JOSEPH B (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:B
Last Name:COCOZZELLA
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 1:10 WINTHROP ST
Mailing Address - Street 2:VERNON MEDICAL CENTER/ 318
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01604-4435
Mailing Address - Country:US
Mailing Address - Phone:508-755-6163
Mailing Address - Fax:
Practice Address - Street 1:10 WINTHROP ST
Practice Address - Street 2:VERNON MEDICAL CENTER/318
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01604-4435
Practice Address - Country:US
Practice Address - Phone:508-755-6163
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-02
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA77122207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAN01614OtherBCBS