Provider Demographics
NPI:1770553927
Name:LOCOCO, VINCENT L (PA)
Entity type:Individual
Prefix:
First Name:VINCENT
Middle Name:L
Last Name:LOCOCO
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:730 S CROUSE AVE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210-1713
Mailing Address - Country:US
Mailing Address - Phone:315-234-4818
Mailing Address - Fax:315-234-4807
Practice Address - Street 1:739 IRVING AVE
Practice Address - Street 2:SUITE 400
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-1640
Practice Address - Country:US
Practice Address - Phone:315-234-6677
Practice Address - Fax:315-234-4808
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY01715306363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01715306Medicaid
NY34594HMedicare ID - Type Unspecified
NYBB6822Medicare ID - Type Unspecified
NY01715306Medicaid