Provider Demographics
NPI:1821076399
Name:TUCCIO, MARK
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:TUCCIO
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 1:844 FAIRMOUNT AVE
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:14701-2520
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:844 FAIRMOUNT AVE
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:NY
Practice Address - Zip Code:14701-2520
Practice Address - Country:US
Practice Address - Phone:716-483-2200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-05
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN0036821213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000000087318OtherGHI HMO
PA179348OtherBLUE CROSS OF PA
PA00010354401OtherUNIVERA (ALL)
NY000500379001OtherBLUE CROSS/BLUE SHIELD
NY000500379004OtherBC/BS DME
PA0010132190001Medicaid
NY01344536Medicaid
PA161233058OtherPRIVATE INSURANCES
NY161233058OtherPRIVATE INSURANCES
NY00010354401OtherUNIVERA (ALL)
PA0010132190001Medicaid
NY000500379001OtherBLUE CROSS/BLUE SHIELD
NYT26619Medicare UPIN
PAT26619Medicare UPIN
NY01344536Medicaid
PA179348GK8Medicare PIN
NY39614CMedicare PIN
NY161233058OtherPRIVATE INSURANCES