Individual
MR. MARK J BUCCI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
C.P.O.
Contact information
Practice address
106 MEDICAL DR, ELIZABETH CITY, NC 27909-3361
(252) 338-3002
Mailing address
106 MEDICAL DR, ELIZABETH CITY, NC 27909-3361
(252) 338-3002
Taxonomy
Speciality
Code
Description
License number
State
222Z00000X
Orthotist
CO005782
—
224P00000X
Prosthetist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CPO04410
AMERICAN BOARD FOR CERTIFICATION IN ORTHOTICS, PROSTHETICS, & PEDORTHICS
NC
Enumeration date
03/06/2018
Last updated
11/08/2019
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