Provider Demographics
NPI:1073502126
Name:DIMARCO, LUCIANO A (DO)
Entity Type:Individual
Prefix:
First Name:LUCIANO
Middle Name:A
Last Name:DIMARCO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:875 S ARLINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17109-5004
Mailing Address - Country:US
Mailing Address - Phone:717-652-1107
Mailing Address - Fax:717-652-1142
Practice Address - Street 1:875 S ARLINGTON AVE
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17109-5004
Practice Address - Country:US
Practice Address - Phone:717-652-1107
Practice Address - Fax:717-652-1142
Is Sole Proprietor?:No
Enumeration Date:2005-10-20
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS006969L208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
E70604Medicare UPIN
596165NITMedicare ID - Type Unspecified