Provider Demographics
NPI:1285622993
Name:BUCCI, LORENZO A (MD)
Entity type:Individual
Prefix:
First Name:LORENZO
Middle Name:A
Last Name:BUCCI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 LINCOLN ST STE 410
Mailing Address - Street 2:
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01702-8200
Mailing Address - Country:US
Mailing Address - Phone:508-820-1650
Mailing Address - Fax:508-872-0370
Practice Address - Street 1:85 LINCOLN ST STE 410
Practice Address - Street 2:
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01702-8200
Practice Address - Country:US
Practice Address - Phone:508-820-1650
Practice Address - Fax:088-720-3705
Is Sole Proprietor?:No
Enumeration Date:2005-10-07
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD044495L208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0012529980002Medicaid
PA0012529980002Medicaid
PA677586Medicare PIN
PA1426826OtherUMWA
PA677586Medicare ID - Type Unspecified
PA60276OtherMEDPLUS
PA4264835OtherAETNA NON-HMO
PA0012529980002Medicaid
PA1665205OtherUPMC
PA1010291OtherGATEWAY
PA234828OtherAETNA HMO