Healthcare Provider Details

I. General information

NPI: 1205450087
Provider Name (Legal Business Name): MARY LEE ACCURSO PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARY LEE BAICH

II. Dates (important events)

Enumeration Date: 06/08/2020
Last Update Date: 01/27/2026
Certification Date: 01/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8591 CROSSROADS DR
YOUNGSTOWN OH
44514-4382
US

IV. Provider business mailing address

8591 CROSSROADS DR
YOUNGSTOWN OH
44514-4382
US

V. Phone/Fax

Practice location:
  • Phone: 330-758-0577
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50.007059RX
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberMA061580
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: