1447239413 NPI number — DR. DANIELLE ELIZABETH LUCIANO M.D.

Table of content: DR. DANIELLE ELIZABETH LUCIANO M.D. (NPI 1447239413)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447239413 NPI number — DR. DANIELLE ELIZABETH LUCIANO M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LUCIANO
Provider First Name:
DANIELLE
Provider Middle Name:
ELIZABETH
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1447239413
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/07/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
263 FARMINGTON AVE
Provider Second Line Business Mailing Address:
PROVIDER ENROLLMENT
Provider Business Mailing Address City Name:
FARMINGTON
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06030-2212
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-679-2792
Provider Business Mailing Address Fax Number:
860-679-1494

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1115 WEST ST
Provider Second Line Business Practice Location Address:
2ND FLOOR
Provider Business Practice Location Address City Name:
SOUTHINGTON
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06489-6025
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-276-6043
Provider Business Practice Location Address Fax Number:
860-276-6059
Provider Enumeration Date:
01/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207VG0400X , with the licence number:  043408 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 7253733 . This is a "AETNA" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: 001434084 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 010043408 CT 01 . This is a "ANTHEM BC & BS NB OFFICE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 010043408 CT 02 . This is a "ANTHEM BC & BS HTFD. OFF" identifier . This identifiers is of the category "OTHER".
  • Identifier: 294113 . This is a "WELLCARE PREFERRED ONE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 2V7377 . This is a "HEALTHNET" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 20-1997579 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 20-1997579 . This is a "PRIVATE HEALTH CARE SYSTE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 20-1997579 . This is a "COMMUNITY HEALTH NETWORK" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".




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