Healthcare Provider Details

I. General information

NPI: 1902005291
Provider Name (Legal Business Name): PATSY BUCCINO D O INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2007
Last Update Date: 10/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

624 YOUNGSTOWN POLAND RD
STRUTHERS OH
44471-1106
US

IV. Provider business mailing address

624 YOUNGSTOWN POLAND RD
STRUTHERS OH
44471-1106
US

V. Phone/Fax

Practice location:
  • Phone: 330-755-1495
  • Fax: 330-755-1497
Mailing address:
  • Phone: 330-755-1495
  • Fax: 330-755-1497

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number004593
License Number StateOH

VIII. Authorized Official

Name: MRS. DIANNA L BAKER
Title or Position: OFFICE MANAGER
Credential:
Phone: 330-755-1495