Healthcare Provider Details

I. General information

NPI: 1598733842
Provider Name (Legal Business Name): ANNE E CUCCIO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2006
Last Update Date: 07/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 STANTON L YOUNG BLVD WP3240
OKLAHOMA CITY OK
73104-5020
US

IV. Provider business mailing address

1122 NE 13TH ST ORI236
OKLAHOMA CITY OK
73117-1039
US

V. Phone/Fax

Practice location:
  • Phone: 405-271-5251
  • Fax:
Mailing address:
  • Phone: 405-271-1515
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number19063
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: