Provider Demographics
NPI:1114548450
Name:LUTHI, DEREK THOMAS (PA-C)
Entity Type:Individual
Prefix:
First Name:DEREK
Middle Name:THOMAS
Last Name:LUTHI
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01301-3275
Mailing Address - Country:US
Mailing Address - Phone:413-325-8500
Mailing Address - Fax:508-363-1504
Practice Address - Street 1:102 MAIN ST
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:MA
Practice Address - Zip Code:01301-3275
Practice Address - Country:US
Practice Address - Phone:413-325-8500
Practice Address - Fax:508-363-1504
Is Sole Proprietor?:No
Enumeration Date:2020-04-28
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPA7972363AM0700X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program