Provider Demographics
NPI:1104822683
Name:FUSCO, CARMINA M (DPM)
Entity Type:Individual
Prefix:
First Name:CARMINA
Middle Name:M
Last Name:FUSCO
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1715 MCCULLOUGH AVE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78212-4046
Mailing Address - Country:US
Mailing Address - Phone:210-732-3668
Mailing Address - Fax:201-732-3338
Practice Address - Street 1:1715 MCCULLOUGH AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78212-4046
Practice Address - Country:US
Practice Address - Phone:210-732-3668
Practice Address - Fax:201-732-3338
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2017-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1812213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB154993OtherWELLMED NETWORKS INC
TX8J1317OtherBCBS
TX0035PTOtherBCBS
TXTXB126362OtherWELLMED
TXTXB126362OtherWELLMED
TXU53629Medicare UPIN