Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0300X | Geriatric Medicine | MD063621L | PA |
NPI | 1073717013 |
---|---|
Provider Name | Dr. Frank Bucolo |
First Address | Eagleville, PA 19403-5272 |
Second Address | Philadelphia, PA 19147-2420 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2007 |
Last Update Date | 08/07/2007 |