Healthcare Provider Details

I. General information

NPI: 1902809288
Provider Name (Legal Business Name): STEVEN T. PUCCIO DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2005
Last Update Date: 07/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 OSTRUM ST PPHP2
BETHLEHEM PA
18015-1000
US

IV. Provider business mailing address

801 OSTRUM ST PPHP2
BETHLEHEM PA
18015-1000
US

V. Phone/Fax

Practice location:
  • Phone: 610-954-1735
  • Fax: 610-954-2429
Mailing address:
  • Phone: 610-954-1735
  • Fax: 610-954-2429

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberOS007746L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: