Basic Information
| Provider Information | |||||||||
| NPI: | 1669429130 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CUCULINO | ||||||||
| FirstName: | GREGORY | ||||||||
| MiddleName: | |||||||||
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| Credential: | MD | ||||||||
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| OtherLastName: | CUCULINO | ||||||||
| OtherFirstName: | GREGORY | ||||||||
| OtherMiddleName: | P | ||||||||
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| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 13973 | ||||||||
| Address2: | HAN EMERGENCY PHYSICIANS | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 19101 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8006662455 | ||||||||
| FaxNumber: | 6106176280 | ||||||||
| Practice Location | |||||||||
| Address1: | 175 EAST CHESTER PIKE | ||||||||
| Address2: | TAYLOR HOSPITAL | ||||||||
| City: | RIDLEY PARK | ||||||||
| State: | PA | ||||||||
| PostalCode: | 19078 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6105956000 | ||||||||
| FaxNumber: | 6106176280 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/28/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | MD067278L | PA | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.