Healthcare Provider Details

I. General information

NPI: 1114126026
Provider Name (Legal Business Name): PAUL PATRICK MUCCINO D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2007
Last Update Date: 12/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 MONUMENT RD SUITE 290
YORK PA
17403-5073
US

IV. Provider business mailing address

1803 MOUNT ROSE AVE SUITE B3
YORK PA
17403-3051
US

V. Phone/Fax

Practice location:
  • Phone: 717-812-4090
  • Fax: 717-812-4092
Mailing address:
  • Phone: 717-851-1405
  • Fax: 717-812-4092

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberOS014388
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207XX0801X
TaxonomyOrthopaedic Trauma Physician
License NumberOS014388
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: