Provider Demographics
NPI:1285727883
Name:BUCCI, MARY KARA (MD)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:KARA
Last Name:BUCCI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:4901 LANG AVE NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-4495
Mailing Address - Country:US
Mailing Address - Phone:505-842-8171
Mailing Address - Fax:
Practice Address - Street 1:8300 CONSTITUTION AVE NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-7613
Practice Address - Country:US
Practice Address - Phone:505-291-2506
Practice Address - Fax:505-559-6568
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2018-09-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXM26132085R0001X
NY2556842085R0001X
AK72892085R0001X
NMMD2016-01602085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM13455087Medicaid
8G3677Medicare ID - Type Unspecified