Provider Demographics
NPI:1922086404
Name:TUCCIO, ANTHONY
Entity Type:Individual
Prefix:
First Name:ANTHONY
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
NYN0035191213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000000085962OtherGHI HMO
NY00010354501OtherUNIVERA
PA179337OtherBLUE CROSS OF PA
PA00010354501OtherUNIVERA (ALL)
NY00050082001OtherBLUE CROSS/BLUE SHIELD
NY00767620Medicaid
PA0010132280001Medicaid
NY161233058OtherPRIVATE INSURANCES
PA161233058OtherPRIVATE INSURANCES
NY00050082005OtherBC/BS DME
PA480010033Medicare PIN
PA00010354501OtherUNIVERA (ALL)
NY00767620Medicaid
PA179337OtherBLUE CROSS OF PA
NYT26618Medicare UPIN
PAT26618Medicare UPIN
PA0010132280001Medicaid
NY00010354501OtherUNIVERA