Provider Demographics
NPI:1386873446
Name:BUCCI, DOMENICK D (MD)
Entity type:Individual
Prefix:DR
First Name:DOMENICK
Middle Name:D
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:KNIGHTS & RED LION ROADS
Mailing Address - Street 2:MEDICAL STAFF OFFICE
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19114
Mailing Address - Country:US
Mailing Address - Phone:215-612-4213
Mailing Address - Fax:215-612-4803
Practice Address - Street 1:KNIGHTS & RED LION ROADS
Practice Address - Street 2:ARIA HEALTH MEDICAL STAFF OFFICE
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19114
Practice Address - Country:US
Practice Address - Phone:215-612-4213
Practice Address - Fax:215-612-4803
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-10
Last Update Date:2009-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD040961L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine