MEDICARE: DR. ROCCO A FULCINITI 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	207QA0401X	Addiction Medicine (Family Medicine) Physician	016883E	PA
2	207V00000X	Obstetrics & Gynecology Physician	016883E	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	528035	OTHER	PA	BLUE CROSS/BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1760422984
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROCCO A FULCINITI M.D.

Provider Business Mailing Address
First Line	:	1 GRAYHURST DR
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15235-5300
Country	:	US
Telephone Number	:	412-673-3800
Fax Number	:	412-673-5848

Provider Business Practice Location Address
First Line	:	1966 LINCOLN WAY
Second Line	:	SUITE 100
City	:	MCKEESPORT
State	:	PA
Zip	:	15131-2416
Country	:	US
Telephone Number	:	412-673-3800
Fax Number	:

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

Provider Enumeration Date	:	06/07/2006
Last Update Date	:	01/23/2020

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