Provider Demographics
NPI:1902005291
Name:PATSY BUCCINO D O INC
Entity Type:Organization
Organization Name:PATSY BUCCINO D O INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIANNA
Authorized Official - Middle Name:L
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-755-1495
Mailing Address - Street 1:624 YOUNGSTOWN POLAND RD
Mailing Address - Street 2:
Mailing Address - City:STRUTHERS
Mailing Address - State:OH
Mailing Address - Zip Code:44471-1106
Mailing Address - Country:US
Mailing Address - Phone:330-755-1495
Mailing Address - Fax:330-755-1497
Practice Address - Street 1:624 YOUNGSTOWN POLAND RD
Practice Address - Street 2:
Practice Address - City:STRUTHERS
Practice Address - State:OH
Practice Address - Zip Code:44471-1106
Practice Address - Country:US
Practice Address - Phone:330-755-1495
Practice Address - Fax:330-755-1497
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-16
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH004593207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0776941Medicaid
OH0776941Medicaid
OHE52022Medicare UPIN
OH0629986Medicare PIN