Provider Demographics
NPI:1568417269
Name:PUCCIO, EDWARD VINCENT (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:VINCENT
Last Name:PUCCIO
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Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 13700-1369
Mailing Address - Street 2:COMMONWEALTH EMERGENCY PHYSICIANS PC
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19191-1369
Mailing Address - Country:US
Mailing Address - Phone:800-666-2455
Mailing Address - Fax:610-617-6280
Practice Address - Street 1:44045 RIVERSIDE PARKWAY
Practice Address - Street 2:LOUDOUN HOSPITAL CENTER
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176
Practice Address - Country:US
Practice Address - Phone:703-858-6040
Practice Address - Fax:610-617-6280
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2007-07-16
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Provider Licenses
StateLicense IDTaxonomies
VA0101052640207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G13926Medicare UPIN