Healthcare Provider Details

I. General information

NPI: 1982673232
Provider Name (Legal Business Name): PATSY BUCCINO D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/17/2006
Last Update Date: 08/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 S STATE ST
GIRARD OH
44420-2907
US

IV. Provider business mailing address

24 SOUTH STATE STREET
GIRARD OH
44420-2907
US

V. Phone/Fax

Practice location:
  • Phone: 330-545-3467
  • Fax: 330-545-5041
Mailing address:
  • Phone: 330-545-3467
  • Fax: 330-545-5041

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number34-00-4593-B
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: