Provider Demographics
NPI:1528142791
Name:BUCCO, MARIA CAMILLA (DO, FACP)
Entity type:Individual
Prefix:DR
First Name:MARIA
Middle Name:CAMILLA
Last Name:BUCCO
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Gender:F
Credentials:DO, FACP
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Mailing Address - Street 1:1088 W BALTIMORE PIKE
Mailing Address - Street 2:SUITE 2104 HEALTH CENTER 2
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063-5146
Mailing Address - Country:US
Mailing Address - Phone:610-744-2980
Mailing Address - Fax:610-744-2982
Practice Address - Street 1:1088 W BALTIMORE PIKE
Practice Address - Street 2:SUITE 2104 HEALTH CENTER 2
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-5146
Practice Address - Country:US
Practice Address - Phone:610-744-2980
Practice Address - Fax:610-744-2982
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2016-08-31
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Provider Licenses
StateLicense IDTaxonomies
PAOS006967L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAE52636Medicare UPIN
608932Medicare ID - Type Unspecified
PA1728819Medicaid