Provider Demographics
NPI:1053707174
Name:PLUCHINO, FABRIZIO (MD PHD)
Entity type:Individual
Prefix:DR
First Name:FABRIZIO
Middle Name:
Last Name:PLUCHINO
Suffix:
Gender:M
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 CRAIWELL AVE
Mailing Address - Street 2:
Mailing Address - City:WEST SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01089-2915
Mailing Address - Country:US
Mailing Address - Phone:617-415-8429
Mailing Address - Fax:
Practice Address - Street 1:103 CRAIWELL AVE
Practice Address - Street 2:
Practice Address - City:WEST SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01089-2915
Practice Address - Country:US
Practice Address - Phone:617-415-8429
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-15
Last Update Date:2015-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL185564364SM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SM0705XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistMedical-Surgical