Provider Demographics
NPI:1336180462
Name:ALLOCCO, DOMINIC JOHN (MD)
Entity Type:Individual
Prefix:DR
First Name:DOMINIC
Middle Name:JOHN
Last Name:ALLOCCO
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 1:4221 COUNTRY CLUB RD
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55424-1129
Mailing Address - Country:US
Mailing Address - Phone:617-283-7721
Mailing Address - Fax:
Practice Address - Street 1:1 SCIMED PL
Practice Address - Street 2:
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55311
Practice Address - Country:US
Practice Address - Phone:763-494-1985
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2018-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA214149207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease