Provider Demographics
NPI:1871521518
Name:ROCA, DOMINIC J (MD, PHD)
Entity type:Individual
Prefix:
First Name:DOMINIC
Middle Name:J
Last Name:ROCA
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:190 W BROAD ST
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06902-3633
Mailing Address - Country:US
Mailing Address - Phone:203-348-2437
Mailing Address - Fax:203-276-7243
Practice Address - Street 1:190 W BROAD ST
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902-3633
Practice Address - Country:US
Practice Address - Phone:203-348-2437
Practice Address - Fax:203-276-7243
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT037780207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
G72580Medicare UPIN