Provider Demographics
NPI:1952585259
Name:DEBRA J. PANUCCI, MD, LLC
Entity type:Organization
Organization Name:DEBRA J. PANUCCI, MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:J
Authorized Official - Last Name:PANUCCI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-217-7194
Mailing Address - Street 1:PO BOX 823
Mailing Address - Street 2:
Mailing Address - City:MC MURRAY
Mailing Address - State:PA
Mailing Address - Zip Code:15317-0823
Mailing Address - Country:US
Mailing Address - Phone:412-217-7194
Mailing Address - Fax:
Practice Address - Street 1:155 WILSON AVE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:15301-3336
Practice Address - Country:US
Practice Address - Phone:724-250-6093
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-21
Last Update Date:2007-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD039510E208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
E57719Medicare UPIN