Provider Demographics
NPI:1326062241
Name:PANUCCI, DEBRA J (MD)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:J
Last Name:PANUCCI
Suffix:
Gender:F
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:P.O. BOX 823
Mailing Address - Street 2:
Mailing Address - City:MCMURRAY
Mailing Address - State:PA
Mailing Address - Zip Code:15317
Mailing Address - Country:US
Mailing Address - Phone:412-217-7194
Mailing Address - Fax:
Practice Address - Street 1:CANONSBURG HOSPITAL
Practice Address - Street 2:100 MEDICAL BLVD.
Practice Address - City:CANONSBURG
Practice Address - State:PA
Practice Address - Zip Code:15317
Practice Address - Country:US
Practice Address - Phone:724-745-3908
Practice Address - Fax:724-873-5873
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2017-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD039510E208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
E59919Medicare UPIN