Provider Demographics
NPI:1023070976
Name:PUCCIO, CARMELO ANTHONY (MD)
Entity type:Individual
Prefix:
First Name:CARMELO
Middle Name:ANTHONY
Last Name:PUCCIO
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:PO BOX 69
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:NY
Mailing Address - Zip Code:10532-0069
Mailing Address - Country:US
Mailing Address - Phone:914-493-8375
Mailing Address - Fax:914-347-1832
Practice Address - Street 1:19 BRADHURST AVE
Practice Address - Street 2:SUITE 2100
Practice Address - City:HAWTHORNE
Practice Address - State:NY
Practice Address - Zip Code:10532-2140
Practice Address - Country:US
Practice Address - Phone:914-493-8375
Practice Address - Fax:914-347-1832
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2010-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY145841207RH0003X, 207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01085390Medicaid
NYA61043Medicare UPIN
NY01085390Medicaid