=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821903840
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARY LUIGIA BUCCIERO PA-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/14/2026
-----------------------------------------------------
Last Update Date | 08/14/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4 CONGRESS PL
-----------------------------------------------------
City | SARATOGA SPGS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12866-4180
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 518-450-4594
-----------------------------------------------------
Fax | 518-450-4595
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 517 WAITE RD
-----------------------------------------------------
City | REXFORD
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12148-1339
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 518-598-2593
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------