Provider Demographics
NPI:1528157898
Name:FUSCO, CYNTHIA R (DO)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:R
Last Name:FUSCO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8500-6335
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-6335
Mailing Address - Country:US
Mailing Address - Phone:215-807-8000
Mailing Address - Fax:215-612-5438
Practice Address - Street 1:3998 RED LION RD
Practice Address - Street 2:TRAUMA DEPARTMENT
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19114-1445
Practice Address - Country:US
Practice Address - Phone:215-612-4064
Practice Address - Fax:215-612-5438
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2015-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB080108207P00000X
PAOS008129L207P00000X, 2086S0127X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2969360OtherAET NA HMO
PA0016376610013Medicaid
PA5508477OtherAETNA PPO
PA0016376610013Medicaid
G49096Medicare UPIN
PA227799JL1Medicare PIN