Basic Information
| Provider Information | |||||||||
| NPI: | 1033164207 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PASCUZZI | ||||||||
| FirstName: | MARK | ||||||||
| MiddleName: | JOSEPH | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 225 HOSPITAL DR | ||||||||
| Address2: | BLDG B, STE 255 | ||||||||
| City: | WINCHESTER | ||||||||
| State: | KY | ||||||||
| PostalCode: | 403917676 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8597442623 | ||||||||
| FaxNumber: | 8597449421 | ||||||||
| Practice Location | |||||||||
| Address1: | 225 HOSPITAL DR | ||||||||
| Address2: | BLDG B, STE 255 | ||||||||
| City: | WINCHESTER | ||||||||
| State: | KY | ||||||||
| PostalCode: | 403917676 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8597442623 | ||||||||
| FaxNumber: | 8597449421 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/24/2006 | ||||||||
| LastUpdateDate: | 05/04/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 05/04/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 22056 | KY | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 000000049460 | 01 | KY | BCBS | OTHER | AP1715563 | 01 | DEA | OTHER | 64220569 | 05 | KY | MEDICAID |