Provider Demographics
NPI:1588632053
Name:MASUCCI, DOUGLAS JOSEPH (MD)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:JOSEPH
Last Name:MASUCCI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:PA
Mailing Address - Zip Code:17331-2503
Mailing Address - Country:US
Mailing Address - Phone:717-632-8944
Mailing Address - Fax:717-632-1224
Practice Address - Street 1:217 BROADWAY
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:PA
Practice Address - Zip Code:17331-2503
Practice Address - Country:US
Practice Address - Phone:717-632-8944
Practice Address - Fax:717-632-1224
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD041153-E208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0011203440002Medicaid
PA0011203440002Medicaid
037384Medicare ID - Type Unspecified