Provider Demographics
NPI:1629240155
Name:PICURRO CPO, MARK C
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:C
Last Name:PICURRO CPO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 NORTH ST STE 6
Mailing Address - Street 2:
Mailing Address - City:PRESQUE ISLE
Mailing Address - State:ME
Mailing Address - Zip Code:04769-2269
Mailing Address - Country:US
Mailing Address - Phone:207-762-3808
Mailing Address - Fax:
Practice Address - Street 1:40 NORTH ST STE 6
Practice Address - Street 2:
Practice Address - City:PRESQUE ISLE
Practice Address - State:ME
Practice Address - Zip Code:04769-2269
Practice Address - Country:US
Practice Address - Phone:207-762-3808
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-25
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist