Provider Demographics
NPI:1841218708
Name:PASCUCCI, MARY FRANCES (DO)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:FRANCES
Last Name:PASCUCCI
Suffix:
Gender:F
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:PO BOX 1388
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:PA
Mailing Address - Zip Code:18704-0388
Mailing Address - Country:US
Mailing Address - Phone:570-288-8881
Mailing Address - Fax:570-288-8065
Practice Address - Street 1:148 N SHERMAN CT
Practice Address - Street 2:
Practice Address - City:HAZLETON
Practice Address - State:PA
Practice Address - Zip Code:18201-5863
Practice Address - Country:US
Practice Address - Phone:570-454-6301
Practice Address - Fax:570-454-6815
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2015-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS007234L207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0016400030005Medicaid
PA950526OtherBLUE SHIELD
PA950526J4JMedicare ID - Type Unspecified
G51450Medicare UPIN