Provider Demographics
NPI:1285729624
Name:COCONCEA, NICOLETA (MD)
Entity type:Individual
Prefix:MRS
First Name:NICOLETA
Middle Name:
Last Name:COCONCEA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 SPICE MILL LN
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19808-3300
Mailing Address - Country:US
Mailing Address - Phone:617-763-7093
Mailing Address - Fax:617-507-3482
Practice Address - Street 1:5700 KIRKWOOD HWY STE 107
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19808
Practice Address - Country:US
Practice Address - Phone:302-224-1711
Practice Address - Fax:302-513-9967
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2019-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2339612084P0800X
OH35-0747352084P0805X
DEC1-00119192084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH364031Medicaid
OH364031Medicaid