1114915303 NPI number — ORLANDO DELUCIA MD

Table of content: ORLANDO DELUCIA MD (NPI 1114915303)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114915303 NPI number — ORLANDO DELUCIA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DELUCIA
Provider First Name:
ORLANDO
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1114915303
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/05/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
399 FARMINGTON AVE
Provider Second Line Business Mailing Address:
SUITE 210
Provider Business Mailing Address City Name:
FARMINGTON
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06032-1936
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-548-7338
Provider Business Mailing Address Fax Number:
860-524-2654

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
399 FARMINGTON AVE
Provider Second Line Business Practice Location Address:
SUITE 210
Provider Business Practice Location Address City Name:
FARMINGTON
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06032-1936
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-548-7338
Provider Business Practice Location Address Fax Number:
860-524-2654
Provider Enumeration Date:
10/11/2005

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: 208200000X , with the licence number:  036806 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2086S0122X , with the licence number: 036806 , 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: 0368061384 . This is a "CONNECTICARE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: P1131448 . This is a "OXFORD" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 010036806CT01 . This is a "ANTHEM BCBS" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 06-1406459 . This is a "CORVEL" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 06-1406459 . This is a "GREAT WEST HEALTHCARE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 06-1406459 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 06-1406459 . This is a "NORTHEAST HEALTH DIRECT" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 3183033 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4273999 001 . This is a "CIGNA" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 06-1406459 . This is a "PRIVATE HEALTHCARE SYSTEM" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 0S0381 . This is a "HEALTH NET" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 2055859 . This is a "AETNA" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 23415 . This is a "HEALTH NEW ENGLAND" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 001368069 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 06-1406459 . This is a "FOCUS" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 06-1406459 . This is a "HMC, PPO" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 06-1406459 . This is a "COLONIAL COOPERATIVE CARE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 06-1406459 . This is a "MULTIPLAN" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".




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