Individual
GERRY BOCCAROSSA
Active
Individual
GERRY BOCCAROSSA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DO
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
0102201244
VA
207R00000X
Internal Medicine Physician
Primary
DO 1162
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
005830494
—
VA
05
—
3304613
—
TN
Enumeration date
06/09/2005
Last updated
09/02/2011
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