Provider Demographics
NPI:1437168929
Name:MARCUCCI, PEDRO A (MD)
Entity Type:Individual
Prefix:
First Name:PEDRO
Middle Name:A
Last Name:MARCUCCI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:PEDRO
Other - Middle Name:A
Other - Last Name:MARCUCCI-LABOY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2234 COLONIAL BLVD
Mailing Address - Street 2:MANAGED CARE DEPT.
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1412
Mailing Address - Country:US
Mailing Address - Phone:239-931-7342
Mailing Address - Fax:239-931-7382
Practice Address - Street 1:18900 N TAMIAMI TRL
Practice Address - Street 2:SUITE A12
Practice Address - City:NORTH FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33903-7312
Practice Address - Country:US
Practice Address - Phone:239-458-0168
Practice Address - Fax:239-458-3925
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2009-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME86865208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL7016304OtherAETNA PROVIDER #
FL8892692OtherCIGNA PROVIDER #
FLP00445995OtherRAILROAD MEDICARE
FL57661OtherBCBS OF FLORIDA PROV. #
FL57661ZMedicare PIN
FL57661OtherBCBS OF FLORIDA PROV. #