Provider Demographics
NPI:1477022606
Name:PUCELL, ANTHONY GEORGE (MD)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:GEORGE
Last Name:PUCELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1120 GORDON RD
Mailing Address - Street 2:
Mailing Address - City:LYNDHURST
Mailing Address - State:OH
Mailing Address - Zip Code:44124-1335
Mailing Address - Country:US
Mailing Address - Phone:440-461-4465
Mailing Address - Fax:
Practice Address - Street 1:1120 GORDON RD
Practice Address - Street 2:
Practice Address - City:LYNDHURST
Practice Address - State:OH
Practice Address - Zip Code:44124-1335
Practice Address - Country:US
Practice Address - Phone:440-461-4465
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-16
Last Update Date:2018-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.037944208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics