Provider Demographics
NPI:1144283250
Name:BUCCOLA, JANET MARIE (MD)
Entity type:Individual
Prefix:DR
First Name:JANET
Middle Name:MARIE
Last Name:BUCCOLA
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:1526 COLE BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80401-3410
Mailing Address - Country:US
Mailing Address - Phone:303-379-9371
Mailing Address - Fax:303-284-4082
Practice Address - Street 1:4401 ROCKSIDE RD STE 214
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:OH
Practice Address - Zip Code:44131-2147
Practice Address - Country:US
Practice Address - Phone:330-626-1113
Practice Address - Fax:330-626-1133
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-10
Last Update Date:2018-11-08
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Provider Licenses
StateLicense IDTaxonomies
MA218808207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H90148Medicare UPIN