Provider Demographics
NPI:1568455913
Name:BUCCINO, DEBORAH (MD)
Entity Type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:
Last Name:BUCCINO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 MAPLE AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:GREAT BARRINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01230-1965
Mailing Address - Country:US
Mailing Address - Phone:413-528-4047
Mailing Address - Fax:413-528-3407
Practice Address - Street 1:100 MAPLE AVE STE 1
Practice Address - Street 2:
Practice Address - City:GREAT BARRINGTON
Practice Address - State:MA
Practice Address - Zip Code:01230-1965
Practice Address - Country:US
Practice Address - Phone:413-528-4047
Practice Address - Fax:413-528-3407
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2007-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA151501208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
151501OtherTUFTS HEALTH PLAN
P722165OtherOXFORD
01668780OtherNY MEDICAID
26599OtherMVP
073130OtherCTCARE
10029271OtherCDPHP
18701OtherHEALTH NEW ENGLAND
J17043OtherBCBS OF MASS
000000020949OtherBMC HEALTHNET
005026765OtherAETNA
MA3156591Medicaid
1385731OtherUNITED HEALTH
G41354OtherHARVARD PILGRIM HEALTH PL
102755OtherCIGNA
28097OtherCHILDRENS MEDICAL SEC
MA4407OtherHEALTHNET OF THE NE INC
MA4407OtherHEALTHNET OF THE NE INC
P722165OtherOXFORD