Provider Demographics
NPI:1568451821
Name:PUCEVICH, MARIA VALIENTE (MD)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:VALIENTE
Last Name:PUCEVICH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:500 CHERRINGTON PKWY STE 410
Mailing Address - Street 2:
Mailing Address - City:CORAOPOLIS
Mailing Address - State:PA
Mailing Address - Zip Code:15108-4749
Mailing Address - Country:US
Mailing Address - Phone:412-262-1064
Mailing Address - Fax:412-262-3904
Practice Address - Street 1:500 CHERRINGTON PKWY STE 410
Practice Address - Street 2:
Practice Address - City:CORAOPOLIS
Practice Address - State:PA
Practice Address - Zip Code:15108-4749
Practice Address - Country:US
Practice Address - Phone:412-262-1064
Practice Address - Fax:412-262-3904
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-19
Last Update Date:2020-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD027600E207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
B41837Medicare UPIN
PA438695Medicare PIN