Provider Demographics
NPI:1245299957
Name:DICOCCO, MARK H (DO)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:H
Last Name:DICOCCO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:330 PEMBROKE LN
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23238-6221
Mailing Address - Country:US
Mailing Address - Phone:804-672-4839
Mailing Address - Fax:804-213-9783
Practice Address - Street 1:16618 MOUNTAIN RD
Practice Address - Street 2:SUITE B
Practice Address - City:MONTPELIER
Practice Address - State:VA
Practice Address - Zip Code:23192-2649
Practice Address - Country:US
Practice Address - Phone:804-883-0552
Practice Address - Fax:804-883-0054
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2010-10-22
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Provider Licenses
StateLicense IDTaxonomies
VA0102201376207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1043523087OtherGROUP NPI