Provider Demographics
NPI:1114126026
Name:MUCCINO, PAUL PATRICK (DO)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:PATRICK
Last Name:MUCCINO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1803 MOUNT ROSE AVE
Mailing Address - Street 2:SUITE B3
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17403-3051
Mailing Address - Country:US
Mailing Address - Phone:717-851-1405
Mailing Address - Fax:717-812-4092
Practice Address - Street 1:25 MONUMENT RD
Practice Address - Street 2:SUITE 290
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403-5073
Practice Address - Country:US
Practice Address - Phone:717-812-4090
Practice Address - Fax:717-812-4092
Is Sole Proprietor?:No
Enumeration Date:2007-07-12
Last Update Date:2016-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS014388207X00000X, 207XX0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XX0801XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Trauma
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA20091810OtherAMERIHEALTH MERCY-WMG
PA102158456Medicaid
WV3810012464Medicaid
MD956309OtherCAREFIRST MD BCBS-WMG
PA1571748OtherGATEWAY-WMG
PA279555OtherUNISON-WMG
MD037915800Medicaid
PA2053366OtherHIGHMARK BLUE SHIELD
PA2053366OtherHIGHMARK BLUE SHIELD
PA1571748OtherGATEWAY-WMG
PA126781Medicare PIN