Healthcare Provider Details

I. General information

NPI: 1598903999
Provider Name (Legal Business Name): ANITA PASCUCCI D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2009
Last Update Date: 05/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9714 HEALTHWAY DR
BERLIN MD
21811-1154
US

IV. Provider business mailing address

9714 HEALTHWAY DR
BERLIN MD
21811-1154
US

V. Phone/Fax

Practice location:
  • Phone: 410-641-3340
  • Fax:
Mailing address:
  • Phone: 410-641-3340
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberH0071514
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: