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NPI Code Detail

MEDICARE: MARK W TUCCILLO DO

MEDICARE: MARK W TUCCILLO DO
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
1207QS0010XSports Medicine (Family Medicine) PhysicianAA2935AK

General Provider Information

NPI Number : 1942237441
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARK W TUCCILLO DO
Provider Business Mailing Address
First Line : PO BOX 2120
Second Line :
City : PETERSBURG
State : AK
Zip : 99833-2120
Country : US
Telephone Number : 907-772-3975
Fax Number :
Provider Business Practice Location Address
First Line : 103 FRAM STREET
Second Line :
City : PETERSBURG
State : AK
Zip : 99833-0589
Country : US
Telephone Number : 907-772-4299
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/28/2006
Last Update Date : 07/08/2007

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Directions to “ MARK W TUCCILLO DO” Practice Location

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