Provider Demographics
NPI:1225304280
Name:LUCKING, SARA MARIAN SEIBERT (MD)
Entity Type:Individual
Prefix:
First Name:SARA MARIAN
Middle Name:SEIBERT
Last Name:LUCKING
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SARA MARIAN
Other - Middle Name:
Other - Last Name:SEIBERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1650 CROOKED OAK DR
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-4278
Mailing Address - Country:US
Mailing Address - Phone:717-569-3279
Mailing Address - Fax:717-509-5297
Practice Address - Street 1:1650 CROOKED OAK DR
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-4278
Practice Address - Country:US
Practice Address - Phone:717-569-3279
Practice Address - Fax:717-509-5297
Is Sole Proprietor?:No
Enumeration Date:2012-03-23
Last Update Date:2016-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD456384207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA521518DW4Medicare PIN