Healthcare Provider Details

I. General information

NPI: 1013910660
Provider Name (Legal Business Name): DEBORAH A SCULCO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2005
Last Update Date: 01/30/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4950 STATE HIGHWAY 30 CANCER MEDICINE CENTER
AMSTERDAM NY
12010-7520
US

IV. Provider business mailing address

4950 STATE HIGHWAY 30 CANCER MEDICINE CENTER
AMSTERDAM NY
12010-7520
US

V. Phone/Fax

Practice location:
  • Phone: 518-770-7557
  • Fax: 518-770-7558
Mailing address:
  • Phone: 518-770-7557
  • Fax: 518-770-7558

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number60470
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number259006
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: