1538188743 NPI number — VINCENT LUCENTE MD F A C O G PC

Table of content: (NPI 1538188743)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538188743 NPI number — VINCENT LUCENTE MD F A C O G PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VINCENT LUCENTE MD F A C O G PC
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:
6
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:
1538188743
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/17/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3050 HAMILTON BLVD.
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
ALLENTOWN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18103-3628
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-435-9575
Provider Business Mailing Address Fax Number:
610-435-2763

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3050 HAMILTON BLVD.
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
ALLENTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18103-3628
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-435-9575
Provider Business Practice Location Address Fax Number:
610-435-2763
Provider Enumeration Date:
07/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LUCENTE
Authorized Official First Name:
VINCENT
Authorized Official Middle Name:
R
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
610-435-9575

Provider Taxonomy Codes

  • Taxonomy code: 207VF0040X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2052999000 . This is a "INDEPENDANCE BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1360068 . This is a "HIGHMARK BLUE SHIELD GROU" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 03233300 . This is a "CAPITAL BLUE CROSS GROUP" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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