MEDICARE: ANTHONY LEE CUCUZZELLA 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	208100000X	Physical Medicine & Rehabilitation Physician	C10000217	DE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	754219	OTHER	DE	UNITED HEALTH CARE
2	4198420	OTHER	DE	AETNA
3	0071916000	OTHER	DE	AMERIHEALTH
4	510110596	OTHER	DE	BCBS DE
5	190B	OTHER	DE	COVENTRY

General Provider Information

NPI Number	:	1710948260
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANTHONY LEE CUCUZZELLA MD

Provider Business Mailing Address
First Line	:	4735 OGLETOWN-STANTON RD
Second Line	:	SUITE 2210
City	:	NEWARK
State	:	DE
Zip	:	19713
Country	:	US
Telephone Number	:	302-623-4144
Fax Number	:	602-623-4147

Provider Business Practice Location Address
First Line	:	4735 OGLETOWN-STANTON RD
Second Line	:	SUITE 2210
City	:	NEWARK
State	:	DE
Zip	:	19713
Country	:	US
Telephone Number	:	302-623-4144
Fax Number	:	602-623-4147

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

Provider Enumeration Date	:	03/31/2006
Last Update Date	:	11/25/2009

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