Provider Demographics
NPI:1235281122
Name:MARCUCCI, JOHN CHRISTIAN (BOCOP, CPO)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:CHRISTIAN
Last Name:MARCUCCI
Suffix:
Gender:M
Credentials:BOCOP, CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4007 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06606-2707
Mailing Address - Country:US
Mailing Address - Phone:203-372-7112
Mailing Address - Fax:
Practice Address - Street 1:4007 MAIN ST
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06606-2707
Practice Address - Country:US
Practice Address - Phone:203-372-7112
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT5334720001Medicare NSC