Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QG0300X | Family Doctor - Geriatric Medicine | MD035862L | PA |
NPI | 1306837646 |
---|---|
Provider Name | William A Dicuccio |
First Address | Butler, PA 16001-4780 |
Second Address | Butler, PA 16001-4780 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/11/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0006778130003 | (05) | PA |
C32381 | (02) |