Provider Demographics
NPI:1851407183
Name:PACIUCCI, PAOLO A (MD)
Entity Type:Individual
Prefix:
First Name:PAOLO
Middle Name:A
Last Name:PACIUCCI
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 1:900 SW 16TH ST., SUITE #100
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98057
Mailing Address - Country:US
Mailing Address - Phone:425-204-7480
Mailing Address - Fax:425-204-7481
Practice Address - Street 1:900 SW 16TH ST., SUITE 100
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98057
Practice Address - Country:US
Practice Address - Phone:425-204-7480
Practice Address - Fax:425-204-7481
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2014-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY153498207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
85E071Medicare ID - Type Unspecified
E62794Medicare UPIN