Provider Demographics
NPI:1942257001
Name:FUCCI, PASQUALE (MD)
Entity Type:Individual
Prefix:
First Name:PASQUALE
Middle Name:
Last Name:FUCCI
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 1:1815 W 13TH ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19806-4054
Mailing Address - Country:US
Mailing Address - Phone:302-652-4705
Mailing Address - Fax:302-652-2917
Practice Address - Street 1:1815 W 13TH ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19806-4054
Practice Address - Country:US
Practice Address - Phone:302-652-4705
Practice Address - Fax:302-652-2917
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-27
Last Update Date:2015-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC10003583207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000426601Medicaid
DE0000426601Medicaid
DE000V15B68Medicare ID - Type Unspecified