Provider Demographics
NPI:1902364862
Name:BUCCI, NATHANIEL ROBERT (PA-C)
Entity Type:Individual
Prefix:
First Name:NATHANIEL
Middle Name:ROBERT
Last Name:BUCCI
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1619 SQUAW CT
Mailing Address - Street 2:
Mailing Address - City:GIRARD
Mailing Address - State:OH
Mailing Address - Zip Code:44420-3632
Mailing Address - Country:US
Mailing Address - Phone:330-219-0519
Mailing Address - Fax:
Practice Address - Street 1:60 WEST ST
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:OH
Practice Address - Zip Code:44041-9723
Practice Address - Country:US
Practice Address - Phone:440-491-0155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-08
Last Update Date:2019-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.005787RX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant