MEDICARE: DENISE PANUCCIO MD PA

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	:	1558402792
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DENISE PANUCCIO MD PA

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

Provider Business Practice Location Address
First Line	:	1200 W SR 434 STE 112
Second Line	:
City	:	LONGWOOD
State	:	FL
Zip	:	32750-4957
Country	:	US
Telephone Number	:	407-869-8747
Fax Number	:	407-896-8108

Authorized Official
Title or Position	:	CEO
Name	:	DENISE PANUCCIO
Credential	:	M.D.
Telephone Number	:	407-869-8747

Provider Enumeration Date	:	02/09/2007
Last Update Date	:	08/20/2024

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Directions to “DENISE PANUCCIO MD PA ” Practice Location

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