=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114126026
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PAUL PATRICK MUCCINO D.O.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/12/2007
-----------------------------------------------------
Last Update Date | 12/19/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 25 MONUMENT RD SUITE 290
-----------------------------------------------------
City | YORK
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17403-5073
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 717-812-4090
-----------------------------------------------------
Fax | 717-812-4092
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1803 MOUNT ROSE AVE SUITE B3
-----------------------------------------------------
City | YORK
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17403-3051
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 717-851-1405
-----------------------------------------------------
Fax | 717-812-4092
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207X00000X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Surgery Physician
-----------------------------------------------------
License Number | OS014388
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207XX0801X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Trauma Physician
-----------------------------------------------------
License Number | OS014388
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------