Provider Demographics
NPI:1760422984
Name:FULCINITI, ROCCO A (MD)
Entity Type:Individual
Prefix:DR
First Name:ROCCO
Middle Name:A
Last Name:FULCINITI
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 1:1 GRAYHURST DR
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15235-5300
Mailing Address - Country:US
Mailing Address - Phone:412-673-3800
Mailing Address - Fax:412-673-5848
Practice Address - Street 1:1966 LINCOLN WAY
Practice Address - Street 2:SUITE 100
Practice Address - City:MCKEESPORT
Practice Address - State:PA
Practice Address - Zip Code:15131-2416
Practice Address - Country:US
Practice Address - Phone:412-673-3800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA016883E207QA0401X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA528035OtherBLUE CROSS/BLUE SHIELD
PA0678042Medicaid
PA0678042Medicaid
153869Medicare ID - Type Unspecified