Provider Demographics
NPI:1750529897
Name:MARIA C BUCCO, DO, PC
Entity type:Organization
Organization Name:MARIA C BUCCO, DO, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:CAMILLA
Authorized Official - Last Name:BUCCO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:610-744-2980
Mailing Address - Street 1:1088 W BALTIMORE PIKE
Mailing Address - Street 2:HEALTH CARE CENTER II SUITE 2104
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063-5146
Mailing Address - Country:US
Mailing Address - Phone:610-744-2980
Mailing Address - Fax:610-744-2982
Practice Address - Street 1:1088 W BALTIMORE PIKE
Practice Address - Street 2:HEALTH CARE CENTER II SUITE 2104
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-5146
Practice Address - Country:US
Practice Address - Phone:610-744-2980
Practice Address - Fax:610-744-2982
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-28
Last Update Date:2009-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS006967L261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty