Provider Demographics
NPI:1225197452
Name:LIZZI, LUCIANO (MD, JD)
Entity Type:Individual
Prefix:DR
First Name:LUCIANO
Middle Name:
Last Name:LIZZI
Suffix:
Gender:M
Credentials:MD, JD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4830 INNISBROOK CT APT 1003
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29579-6609
Mailing Address - Country:US
Mailing Address - Phone:610-896-8580
Mailing Address - Fax:
Practice Address - Street 1:4830 INNISBROOK CT APT 1003
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29579-6609
Practice Address - Country:US
Practice Address - Phone:610-896-8580
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD026410E2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAB40604Medicare UPIN
PA171054Medicare ID - Type UnspecifiedMEDICARE NUMBER