Provider Demographics
NPI:1316208390
Name:BUCCIARELLI, MAURA (DO)
Entity type:Individual
Prefix:DR
First Name:MAURA
Middle Name:
Last Name:BUCCIARELLI
Suffix:
Gender:
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:301 LIPPINCOTT DR STE 410
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-4197
Mailing Address - Country:US
Mailing Address - Phone:856-727-0900
Mailing Address - Fax:856-231-8428
Practice Address - Street 1:401 YOUNG AVE STE 245B
Practice Address - Street 2:
Practice Address - City:MOORESTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08057-3132
Practice Address - Country:US
Practice Address - Phone:856-727-0900
Practice Address - Fax:856-231-8428
Is Sole Proprietor?:No
Enumeration Date:2012-06-06
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB10025500207RE0101X
PAOT014477207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0590568Medicaid