Provider Demographics
NPI:1235121807
Name:LUCHT, WILLIAM DEAN (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:DEAN
Last Name:LUCHT
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 1:100 E 15TH AVE
Mailing Address - Street 2:
Mailing Address - City:CONSHOHOCKEN
Mailing Address - State:PA
Mailing Address - Zip Code:19428-2329
Mailing Address - Country:US
Mailing Address - Phone:907-317-7894
Mailing Address - Fax:
Practice Address - Street 1:100 E 15TH AVE
Practice Address - Street 2:
Practice Address - City:CONSHOHOCKEN
Practice Address - State:PA
Practice Address - Zip Code:19428-2329
Practice Address - Country:US
Practice Address - Phone:907-317-7894
Practice Address - Fax:610-825-4182
Is Sole Proprietor?:No
Enumeration Date:2005-08-18
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK4967207R00000X, 207RP1001X, 207RS0012X
PAMD459090207RP1001X, 207RS0012X
IL036.144544207RS0012X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD7285Medicaid
AK4967OtherSTATE LICENSE
AK4967OtherSTATE LICENSE
B91088Medicare UPIN
AKMD7285Medicaid