Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 0101247394 | VA |
Y | 208600000X | Surgeon | 0101247394 | VA |
N | 2086X0206X | Surgical Oncologist | 32878 | DC |
NPI | 1285663153 |
---|---|
Provider Name | Dr. Costanza Cocilovo |
First Address | Fairfax, VA 22031-5218 |
Second Address | Fairfax, VA 22031-4867 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/07/2006 |
Last Update Date | 16/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
P00457611 | MEDICARE RR (01) | DC |