Basic Information
| Provider Information | |||||||||
| NPI: | 1285727883 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BUCCI | ||||||||
| FirstName: | MARY | ||||||||
| MiddleName: | KARA | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4901 LANG AVE NE | ||||||||
| Address2: | |||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871094495 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5058428171 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 8300 CONSTITUTION AVE NE | ||||||||
| Address2: | |||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871107613 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5052912506 | ||||||||
| FaxNumber: | 5055596568 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/02/2006 | ||||||||
| LastUpdateDate: | 09/27/2018 | ||||||||
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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 | 2085R0001X | M2613 | TX | N | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology | 2085R0001X | 255684 | NY | N | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology | 2085R0001X | 7289 | AK | N | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology | 2085R0001X | MD2016-0160 | NM | Y | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology |
ID Information
| ID | Type | State | Issuer | Description | 13455087 | 05 | NM | MEDICAID |