Basic Information
| Provider Information | |||||||||
| NPI: | 1487662789 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MARCUCCI | ||||||||
| FirstName: | LISA | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1803 MOUNT ROSE AVE | ||||||||
| Address2: | SUITE B3 | ||||||||
| City: | YORK | ||||||||
| State: | PA | ||||||||
| PostalCode: | 174033026 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7178511405 | ||||||||
| FaxNumber: | 7178516969 | ||||||||
| Practice Location | |||||||||
| Address1: | 25 MONUMENT RD | ||||||||
| Address2: | SUITE 120 | ||||||||
| City: | YORK | ||||||||
| State: | PA | ||||||||
| PostalCode: | 174035060 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7174286017 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/03/2006 | ||||||||
| LastUpdateDate: | 06/03/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2086S0102X | MD051022L | PA | Y | Allopathic & Osteopathic Physicians | Surgery | Surgical Critical Care | 208600000X | MD051022L | PA | N | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 0112992 | 05 | NJ | MEDICAID | 101451410 | 05 | PA | MEDICAID | 1337199 | 01 | PA | HIGHMARK BLUE SHIELD | OTHER | 50082458 | 01 | PA | CAPITAL BLUE CROSS-WMG | OTHER | 7312750 | 05 | VI | MEDICAID | 259401 | 01 | PA | UNISON-WMG | OTHER | 215501 | 01 | PA | JOHNS HOPKINS | OTHER |