Provider Demographics
NPI:1942299383
Name:PUCEVICH, CHARLES L (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:L
Last Name:PUCEVICH
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 1:500 CHERRINGTON PKWY STE 410
Mailing Address - Street 2:
Mailing Address - City:CORAOPOLIS
Mailing Address - State:PA
Mailing Address - Zip Code:15108-4749
Mailing Address - Country:US
Mailing Address - Phone:412-262-1064
Mailing Address - Fax:412-262-3904
Practice Address - Street 1:500 CHERRINGTON PKWY STE 410
Practice Address - Street 2:
Practice Address - City:CORAOPOLIS
Practice Address - State:PA
Practice Address - Zip Code:15108-4749
Practice Address - Country:US
Practice Address - Phone:412-262-1064
Practice Address - Fax:412-262-3904
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-18
Last Update Date:2017-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD0272SOE207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0863588Medicaid
B35315Medicare UPIN
PA085524Medicare PIN