Individual
LISA MARCUCCI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
25 MONUMENT RD, SUITE 120, YORK, PA 17403-5060
(717) 428-6017
Mailing address
1803 MOUNT ROSE AVE, SUITE B3, YORK, PA 17403-3026
(717) 851-1405
(717) 851-6969
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
MD051022L
PA
2086S0102X
Surgical Critical Care Physician
Primary
MD051022L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0112992
—
NJ
05
—
101451410
—
PA
01
—
1337199
HIGHMARK BLUE SHIELD
PA
01
—
215501
JOHNS HOPKINS
PA
01
—
259401
UNISON-WMG
PA
01
—
50082458
CAPITAL BLUE CROSS-WMG
PA
05
—
7312750
—
VI
Enumeration date
08/03/2006
Last updated
06/03/2013
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