Provider Demographics
NPI:1366425704
Name:BUCCI, FRANK A JR (MD)
Entity type:Individual
Prefix:
First Name:FRANK
Middle Name:A
Last Name:BUCCI
Suffix:JR
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 1:158 WILKES BARRE TOWNSHIP BLVD
Mailing Address - Street 2:
Mailing Address - City:WILKES BARRE
Mailing Address - State:PA
Mailing Address - Zip Code:18702-6704
Mailing Address - Country:US
Mailing Address - Phone:570-825-5949
Mailing Address - Fax:570-825-2645
Practice Address - Street 1:158 WILKES BARRE TOWNSHIP BLVD
Practice Address - Street 2:
Practice Address - City:WILKES BARRE
Practice Address - State:PA
Practice Address - Zip Code:18702-6704
Practice Address - Country:US
Practice Address - Phone:570-825-5949
Practice Address - Fax:570-825-2645
Is Sole Proprietor?:No
Enumeration Date:2005-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD046074L207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA763806OtherBLUE SHIELD
PA0012704590003Medicaid
PA763806OtherBLUE SHIELD
PA691273Medicare ID - Type Unspecified