MEDICARE: DR. DENISE PANUCCIO M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	ME0074995	FL

General Provider Information

NPI Number	:	1134123078
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DENISE PANUCCIO M.D.

Provider Business Mailing Address
First Line	:	1200 W SR 434
Second Line	:	STE 112
City	:	LONGWOOD
State	:	FL
Zip	:	32750-4957
Country	:	US
Telephone Number	:	407-869-8747
Fax Number	:

Provider Business Practice Location Address
First Line	:	1200 W SR 434
Second Line	:	STE 112
City	:	LONGWOOD
State	:	FL
Zip	:	32750-4957
Country	:	US
Telephone Number	:	407-869-8747
Fax Number	:	407-869-8108

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/09/2005
Last Update Date	:	02/24/2017

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