1568455913 NPI number — DR. DEBORAH BUCCINO MD

Table of content: DR. DEBORAH BUCCINO MD (NPI 1568455913)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568455913 NPI number — DR. DEBORAH BUCCINO MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BUCCINO
Provider First Name:
DEBORAH
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1568455913
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/27/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 MAPLE AVE STE 1
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREAT BARRINGTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01230-1965
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
413-528-4047
Provider Business Mailing Address Fax Number:
413-528-3407

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 MAPLE AVE STE 1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREAT BARRINGTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01230-1965
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
413-528-4047
Provider Business Practice Location Address Fax Number:
413-528-3407
Provider Enumeration Date:
08/31/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  151501 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 151501 . This is a "TUFTS HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: P722165 . This is a "OXFORD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 01668780 . This is a "NY MEDICAID" identifier . This identifiers is of the category "OTHER".
  • Identifier: 26599 . This is a "MVP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 073130 . This is a "CTCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 10029271 . This is a "CDPHP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 18701 . This is a "HEALTH NEW ENGLAND" identifier . This identifiers is of the category "OTHER".
  • Identifier: J17043 . This is a "BCBS OF MASS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000000020949 . This is a "BMC HEALTHNET" identifier . This identifiers is of the category "OTHER".
  • Identifier: 005026765 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3156591 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1385731 . This is a "UNITED HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: G41354 . This is a "HARVARD PILGRIM HEALTH PL" identifier . This identifiers is of the category "OTHER".
  • Identifier: 102755 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 28097 . This is a "CHILDRENS MEDICAL SEC" identifier . This identifiers is of the category "OTHER".
  • Identifier: MA4407 . This is a "HEALTHNET OF THE NE INC" identifier . This identifiers is of the category "OTHER".




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