Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | MD445813 | PA |
N | 207ND0101X | MOHS-Micrographic Surgeon | MD445813 | PA |
NPI | 1295998557 |
---|---|
Provider Name | Dr. Brian Edward Pucevich |
First Address | Coraopolis, PA 15108-4744 |
Second Address | Coraopolis, PA 15108-4744 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/07/2008 |
Last Update Date | 20/08/2014 |