1366578783 NPI number — DR. LINDA S PUCCI PH.D.

Table of content: DR. LINDA S PUCCI PH.D. (NPI 1366578783)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366578783 NPI number — DR. LINDA S PUCCI PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PUCCI
Provider First Name:
LINDA
Provider Middle Name:
S
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PH.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PUCCI
Provider Other First Name:
LINDA
Provider Other Middle Name:
MARINACCIO
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PH.D.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1366578783
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
202 RIVER FORD DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MARYVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37804-3902
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
865-983-7544
Provider Business Mailing Address Fax Number:
865-379-8272

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
202 RIVER FORD DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MARYVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37804-3902
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-983-7544
Provider Business Practice Location Address Fax Number:
865-379-8272
Provider Enumeration Date:
02/27/2007

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: 103TC0700X , with the licence number:  P0000002142 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 3089507 . This is a "BLUE CROSS PROVIDER NUMBE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 391457976-01 . This is a "DEERE PROVIDER NUMBER" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 116947 . This is a "VALUEOPTIONS" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 30224 . This is a "CARITEN PROVIDER NUMBER" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 1045131 . This is a "CIGNA PROVIDER NUMBER" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".




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