Provider Demographics
NPI:1003940156
Name:DE LUCA, ANTHONY JOSEPH (MD)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:JOSEPH
Last Name:DE LUCA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 ARBORETUM LN
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:RI
Mailing Address - Zip Code:02809-1593
Mailing Address - Country:US
Mailing Address - Phone:401-253-4583
Mailing Address - Fax:401-245-7121
Practice Address - Street 1:310 MAPLE AVE
Practice Address - Street 2:SUITE L 05-A
Practice Address - City:BARRINGTON
Practice Address - State:RI
Practice Address - Zip Code:02806-3430
Practice Address - Country:US
Practice Address - Phone:401-245-5777
Practice Address - Fax:401-245-7121
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI8086208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIAD 00178Medicaid
RIAD 00178Medicaid