Provider Demographics
NPI:1295998557
Name:PUCEVICH, BRIAN EDWARD (MD)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:EDWARD
Last Name:PUCEVICH
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:500 CHERRINGTON PKWY
Mailing Address - Street 2:SUITE 410
Mailing Address - City:CORAOPOLIS
Mailing Address - State:PA
Mailing Address - Zip Code:15108-4744
Mailing Address - Country:US
Mailing Address - Phone:412-262-1064
Mailing Address - Fax:412-262-3904
Practice Address - Street 1:500 CHERRINGTON PKWY
Practice Address - Street 2:SUITE 410
Practice Address - City:CORAOPOLIS
Practice Address - State:PA
Practice Address - Zip Code:15108-4744
Practice Address - Country:US
Practice Address - Phone:412-262-1064
Practice Address - Fax:412-262-3904
Is Sole Proprietor?:No
Enumeration Date:2008-07-08
Last Update Date:2014-08-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD445813207N00000X, 207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery