Provider Demographics
NPI:1558402792
Name:DENISE PANUCCIO MD PA
Entity Type:Organization
Organization Name:DENISE PANUCCIO MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:PANUCCIO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-869-8747
Mailing Address - Street 1:460 E ALTAMONTE DR
Mailing Address - Street 2:SUITE 2200
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32701-4612
Mailing Address - Country:US
Mailing Address - Phone:407-804-9245
Mailing Address - Fax:
Practice Address - Street 1:460 E ALTAMONTE DR
Practice Address - Street 2:SUITE 2200
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32701-4612
Practice Address - Country:US
Practice Address - Phone:407-869-8747
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0074995207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
E95288Medicare UPIN
AB247Medicare PIN