Provider Demographics
NPI:1093782153
Name:BUCCI, JEFFRIES LG (MD)
Entity Type:Individual
Prefix:
First Name:JEFFRIES
Middle Name:LG
Last Name:BUCCI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7600 OSLER DRIVE
Mailing Address - Street 2:SUITE 310
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-7702
Mailing Address - Country:US
Mailing Address - Phone:410-296-2300
Mailing Address - Fax:410-296-3444
Practice Address - Street 1:7600 OSLER DRIVE
Practice Address - Street 2:SUITE 310
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-7702
Practice Address - Country:US
Practice Address - Phone:410-296-2300
Practice Address - Fax:410-296-3444
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-07
Last Update Date:2014-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0054956208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
H76035Medicare UPIN