Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Michael Albert Colucciello, PA-C

Individual provider Physician Assistant · NPI 1417626359

Michael Albert Colucciello, PA-C is a Physician Assistant in Philadelphia, Pennsylvania. Qualified in 2021, 5 years ago. Practices with University of Penn-Medical Group, a 3,401-clinician group and accepts Medicare assignment. Licensed in Indiana.

Years since qualifying
5
Licensed in
IN
In the registry since
2021
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

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Practice location Address checks out

3737 Market St
Philadelphia, PA 19104-5545
Phone: (215) 316-5151
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 1176156 (IN)

Record details

NPI number1417626359
Entity typeIndividual (Type 1)
GenderMale
Credentials PA-C
Sole proprietorYes
NPI enumeratedSeptember 13, 2021
Last updated in NPPESMarch 28, 2022
Certification dateMarch 28, 2022

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2021 (5 years in practice)
Group practice University Of Penn-Medical Group — 3401 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

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