Basic Information
| Provider Information | |||||||||
| NPI: | 1568455913 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BUCCINO | ||||||||
| FirstName: | DEBORAH | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 MAPLE AVE STE 1 | ||||||||
| Address2: | |||||||||
| City: | GREAT BARRINGTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 012301965 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4135284047 | ||||||||
| FaxNumber: | 4135283407 | ||||||||
| Practice Location | |||||||||
| Address1: | 100 MAPLE AVE STE 1 | ||||||||
| Address2: | |||||||||
| City: | GREAT BARRINGTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 012301965 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4135284047 | ||||||||
| FaxNumber: | 4135283407 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2005 | ||||||||
| LastUpdateDate: | 08/27/2007 | ||||||||
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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 | 208000000X | 151501 | MA | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 151501 | 01 | TUFTS HEALTH PLAN | OTHER | P722165 | 01 | OXFORD | OTHER | 01668780 | 01 | NY MEDICAID | OTHER | 26599 | 01 | MVP | OTHER | 073130 | 01 | CTCARE | OTHER | 10029271 | 01 | CDPHP | OTHER | 18701 | 01 | HEALTH NEW ENGLAND | OTHER | J17043 | 01 | BCBS OF MASS | OTHER | 000000020949 | 01 | BMC HEALTHNET | OTHER | 005026765 | 01 | AETNA | OTHER | 3156591 | 05 | MA | MEDICAID | 1385731 | 01 | UNITED HEALTH | OTHER | G41354 | 01 | HARVARD PILGRIM HEALTH PL | OTHER | 102755 | 01 | CIGNA | OTHER | 28097 | 01 | CHILDRENS MEDICAL SEC | OTHER | MA4407 | 01 | HEALTHNET OF THE NE INC | OTHER |