Provider Demographics
NPI:1487636403
Name:DICUCCIO, WILLIAM CARROLL (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:CARROLL
Last Name:DICUCCIO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:8150 PERRY HWY STE 201
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15237-5200
Mailing Address - Country:US
Mailing Address - Phone:724-741-0044
Mailing Address - Fax:412-369-9566
Practice Address - Street 1:480 E JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:BUTLER
Practice Address - State:PA
Practice Address - Zip Code:16001-4780
Practice Address - Country:US
Practice Address - Phone:724-282-1530
Practice Address - Fax:724-282-0902
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2024-01-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMD422570207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1009897150001Medicaid
I04826Medicare UPIN
688070Medicare ID - Type Unspecified