Provider Demographics
NPI:1932157252
Name:CHIOCCA, ENNIO ANTONIO (MD)
Entity Type:Individual
Prefix:
First Name:ENNIO
Middle Name:ANTONIO
Last Name:CHIOCCA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:111 CYPRESS STREET
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446
Mailing Address - Country:US
Mailing Address - Phone:857-307-0896
Mailing Address - Fax:614-293-4281
Practice Address - Street 1:75 FRANCIS STREET, PB3
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115
Practice Address - Country:US
Practice Address - Phone:617-732-6939
Practice Address - Fax:617-734-8342
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2017-04-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA80881207T00000X, 207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2500252Medicaid
OH4126051Medicare PIN
F99712Medicare UPIN