Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | MD044463L | PA |
NPI | 1003809757 |
---|---|
Provider Name | Kimberly S Bucci |
First Address | Grapeville, PA 15634-0155 |
Second Address | Jeannette, PA 15644-2505 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/08/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0012597100007 | (05) | PA |
601186 | BS (01) | PA |
E16206 | (02) |