MEDICARE: DR. CYRILLE P CUCIO 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	14535	NH
2	207RG0300X	Geriatric Medicine (Internal Medicine) Physician	14535	NH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1417956368
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CYRILLE P CUCIO M.D.

Provider Business Mailing Address
First Line	:	275 MAMMOTH RD STE 4
Second Line	:
City	:	MANCHESTER
State	:	NH
Zip	:	03109-4133
Country	:	US
Telephone Number	:	603-624-4380
Fax Number	:	603-624-4805

Provider Business Practice Location Address
First Line	:	275 MAMMOTH RD STE 4
Second Line	:
City	:	MANCHESTER
State	:	NH
Zip	:	03109-4133
Country	:	US
Telephone Number	:	603-624-4380
Fax Number	:	603-624-4805

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

Provider Enumeration Date	:	07/21/2005
Last Update Date	:	07/19/2021

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