Healthcare Provider Details

I. General information

NPI: 1699572529
Provider Name (Legal Business Name): RICHARD KUCERA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2025
Last Update Date: 02/27/2025
Certification Date: 02/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

127 E FAIRVIEW AVE
CONNELLSVILLE PA
15425-3614
US

IV. Provider business mailing address

127 E FAIRVIEW AVE
CONNELLSVILLE PA
15425-3614
US

V. Phone/Fax

Practice location:
  • Phone: 724-628-7250
  • Fax: 724-628-7250
Mailing address:
  • Phone: 724-628-7250
  • Fax: 724-628-7250

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176P00000X
TaxonomyFuneral Director
License Number010843-L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: