Provider Demographics
NPI:1154419125
Name:GOCCIA, RICHARD J (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:J
Last Name:GOCCIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:982 TIOGUE AVE
Mailing Address - Street 2:
Mailing Address - City:COVENTRY
Mailing Address - State:RI
Mailing Address - Zip Code:02816-6167
Mailing Address - Country:US
Mailing Address - Phone:401-821-6800
Mailing Address - Fax:401-821-8513
Practice Address - Street 1:982 TIOGUE AVE
Practice Address - Street 2:
Practice Address - City:COVENTRY
Practice Address - State:RI
Practice Address - Zip Code:02816-6167
Practice Address - Country:US
Practice Address - Phone:401-821-6800
Practice Address - Fax:401-821-8513
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT028404207P00000X
RIMD12480207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIRG69850Medicaid
RI007060220Medicare PIN
CTD91869Medicare UPIN