Provider Demographics
NPI:1033164207
Name:PASCUZZI, MARK JOSEPH (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:JOSEPH
Last Name:PASCUZZI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:225 HOSPITAL DR
Mailing Address - Street 2:BLDG B, STE 255
Mailing Address - City:WINCHESTER
Mailing Address - State:KY
Mailing Address - Zip Code:40391-7676
Mailing Address - Country:US
Mailing Address - Phone:859-744-2623
Mailing Address - Fax:859-744-9421
Practice Address - Street 1:225 HOSPITAL DR
Practice Address - Street 2:BLDG B, STE 255
Practice Address - City:WINCHESTER
Practice Address - State:KY
Practice Address - Zip Code:40391-7676
Practice Address - Country:US
Practice Address - Phone:859-744-2623
Practice Address - Fax:859-744-9421
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-24
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY22056207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000049460OtherBCBS
KY64220569Medicaid
KY64220569Medicaid
KYK096041Medicare PIN
KY000000049460OtherBCBS
KYC75814Medicare UPIN
KY1977801Medicare PIN