1750581047 NPI number — MARK A. LUCIANNA MD

Table of content: (NPI 1750581047)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750581047 NPI number — MARK A. LUCIANNA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARK A. LUCIANNA MD
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1750581047
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/24/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7530 204TH ST NE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ARLINGTON
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98223-8912
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-435-7337
Provider Business Mailing Address Fax Number:
360-435-3510

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7530 204TH ST NE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ARLINGTON
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98223-8912
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-435-7337
Provider Business Practice Location Address Fax Number:
360-435-3510
Provider Enumeration Date:
07/24/2007

Additional Information

Authorized Official

Authorized Official Last Name:
VANWINKLE
Authorized Official First Name:
LUANNE
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
360-435-7337

Provider Taxonomy Codes

  • Taxonomy code: 261QP2300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 7112196 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0152577 . This is a "DEPT. OF LABOR AND INDUST" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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