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NPI Code Detail

MEDICARE: DR. MARK T CUCUZZELLA M.D.

MEDICARE:  DR. MARK T CUCUZZELLA  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
1207Q00000XFamily Medicine Physician21899WV

Other Identifiers

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

General Provider Information

NPI Number : 1609837194
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MARK T CUCUZZELLA M.D.
Provider Business Mailing Address
First Line : PO BOX 897
Second Line :
City : MORGANTOWN
State : WV
Zip : 26507-0897
Country : US
Telephone Number : 304-293-7401
Fax Number : 304-293-6963
Provider Business Practice Location Address
First Line : 31 TAYLOR ST
Second Line :
City : HARPERS FERRY
State : WV
Zip : 25425-9519
Country : US
Telephone Number : 304-535-6343
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/01/2006
Last Update Date : 04/07/2022

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Directions to “ DR. MARK T CUCUZZELLA M.D.” Practice Location

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