MEDICARE: DR. MARY PUCCIO MD

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	207RH0003X	Hematology & Oncology Physician	193399	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1346223138
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARY PUCCIO MD

Provider Business Mailing Address
First Line	:	24 E MAIN ST
Second Line	:
City	:	BAY SHORE
State	:	NY
Zip	:	11706-8301
Country	:	US
Telephone Number	:	631-666-6752
Fax Number	:	631-666-0684

Provider Business Practice Location Address
First Line	:	24 E MAIN ST
Second Line	:
City	:	BAY SHORE
State	:	NY
Zip	:	11706-8301
Country	:	US
Telephone Number	:	631-666-6752
Fax Number	:	631-666-0684

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

Provider Enumeration Date	:	11/25/2005
Last Update Date	:	12/09/2009

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