Provider Demographics
NPI:1598749012
Name:CARNUCCIO, MICHAEL F (DO)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:F
Last Name:CARNUCCIO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 HIGHVIEW CIR
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19382-1821
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:200 MUNICIPAL DR
Practice Address - Street 2:
Practice Address - City:THORNDALE
Practice Address - State:PA
Practice Address - Zip Code:19372-1016
Practice Address - Country:US
Practice Address - Phone:610-383-6300
Practice Address - Fax:610-383-0114
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2009-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS011990207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA057518D3UMedicare PIN
PAH59928Medicare UPIN