1558350405 NPI number — DR. ANTHONY A LUCIANO M.D.

Table of content: DR. ANTHONY A LUCIANO M.D. (NPI 1558350405)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558350405 NPI number — DR. ANTHONY A LUCIANO M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LUCIANO
Provider First Name:
ANTHONY
Provider Middle Name:
A
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1558350405
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/28/2022
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:
860-276-6020
Provider Business Mailing Address Fax Number:
860-276-6059

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:
10/13/2005

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: 207VE0102X , with the licence number:  17123 , 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: 010017123CT 05 . This is a "ANTHEM BLUE CROSE & BLUE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 2V5829 . This is a "HEALTH NET" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 3786055 . This is a "AETNA USHEALTH CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 010017123CT 04 . This is a "ANTHEM BLUE CROSE & BLUE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 0011711230 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • 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: HAS392 . This is a "OXFORD HEALTH" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 0152719 . This is a "CIGNA -1-800-244-6224" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 001171230-03NB . This is a "ANTHEM BLUE CARE FAMILY P" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 001171230-04HTFD . This is a "ANTHEM BLUE CARE FAMILY P" 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".




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