MEDICARE: PATSY BUCCINO D O INC

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	207KA0200X	Allergy Physician	004593	OH

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	:	1902005291
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PATSY BUCCINO D O INC

Provider Business Mailing Address
First Line	:	624 YOUNGSTOWN POLAND RD
Second Line	:
City	:	STRUTHERS
State	:	OH
Zip	:	44471-1106
Country	:	US
Telephone Number	:	330-755-1495
Fax Number	:	330-755-1497

Provider Business Practice Location Address
First Line	:	624 YOUNGSTOWN POLAND RD
Second Line	:
City	:	STRUTHERS
State	:	OH
Zip	:	44471-1106
Country	:	US
Telephone Number	:	330-755-1495
Fax Number	:	330-755-1497

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MRS. DIANNA L BAKER
Credential	:
Telephone Number	:	330-755-1495

Provider Enumeration Date	:	07/16/2007
Last Update Date	:	10/09/2007

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Directions to “PATSY BUCCINO D O INC ” Practice Location

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