Provider Demographics
NPI:1710948260
Name:CUCUZZELLA, ANTHONY LEE (MD)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:LEE
Last Name:CUCUZZELLA
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 1:4735 OGLETOWN-STANTON RD
Mailing Address - Street 2:SUITE 2210
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713
Mailing Address - Country:US
Mailing Address - Phone:302-623-4144
Mailing Address - Fax:602-623-4147
Practice Address - Street 1:4735 OGLETOWN-STANTON RD
Practice Address - Street 2:SUITE 2210
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713
Practice Address - Country:US
Practice Address - Phone:302-623-4144
Practice Address - Fax:602-623-4147
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2009-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC10000217208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE754219OtherUNITED HEALTH CARE
DE4198420OtherAETNA
DE0071916000OtherAMERIHEALTH
DE510110596OtherBCBS DE
DE190BOtherCOVENTRY
022662P52Medicare ID - Type Unspecified
B66255Medicare UPIN