MEDICARE: LISA D. CURCIO M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2086X0206X	Surgical Oncology Physician	306263	NY
2	208600000X	Surgery Physician	306263	NY
3	208600000X	Surgery Physician	G78151	CA
4	2086X0206X	Surgical Oncology Physician	G78151	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	WG78151B	OTHER	CA	PIN

General Provider Information

NPI Number	:	1306846324
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA D. CURCIO M.D.

Provider Business Mailing Address
First Line	:	1351 ROUTE 55 STE 200
Second Line	:
City	:	LAGRANGEVILLE
State	:	NY
Zip	:	12540-5128
Country	:	US
Telephone Number	:	845-475-9661
Fax Number	:	845-475-9938

Provider Business Practice Location Address
First Line	:	6511 SPRING BROOK AVE STE 101
Second Line	:
City	:	RHINEBECK
State	:	NY
Zip	:	12572-3709
Country	:	US
Telephone Number	:	845-871-3545
Fax Number	:	845-871-3546

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/01/2005
Last Update Date	:	10/20/2020

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