Provider Demographics
NPI:1982673232
Name:BUCCINO, PATSY (DO)
Entity Type:Individual
Prefix:DR
First Name:PATSY
Middle Name:
Last Name:BUCCINO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 SOUTH STATE STREET
Mailing Address - Street 2:
Mailing Address - City:GIRARD
Mailing Address - State:OH
Mailing Address - Zip Code:44420-2907
Mailing Address - Country:US
Mailing Address - Phone:330-545-3467
Mailing Address - Fax:330-545-5041
Practice Address - Street 1:24 S STATE ST
Practice Address - Street 2:
Practice Address - City:GIRARD
Practice Address - State:OH
Practice Address - Zip Code:44420-2907
Practice Address - Country:US
Practice Address - Phone:330-545-3467
Practice Address - Fax:330-545-5041
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-17
Last Update Date:2011-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-00-4593-B207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH341712257OtherFEDERAL ID
OH0776941Medicaid
OH341712257-00OtherBWC GROUP ID NUMBER
OHE52022Medicare UPIN
OH0629985Medicare ID - Type Unspecified