Provider Demographics
NPI:1417956368
Name:CUCIO, CYRILLE P (MD)
Entity Type:Individual
Prefix:DR
First Name:CYRILLE
Middle Name:P
Last Name:CUCIO
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 1:275 MAMMOTH RD STE 4
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03109-4133
Mailing Address - Country:US
Mailing Address - Phone:603-624-4380
Mailing Address - Fax:603-624-4805
Practice Address - Street 1:275 MAMMOTH RD STE 4
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03109-4133
Practice Address - Country:US
Practice Address - Phone:603-624-4380
Practice Address - Fax:603-624-4805
Is Sole Proprietor?:No
Enumeration Date:2005-07-21
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH14535207R00000X, 207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02095063Medicaid
NYCC0814Medicare ID - Type Unspecified
NY02095063Medicaid