Provider Demographics
NPI:1285688150
Name:LUCKY, ANNE W (MD)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:W
Last Name:LUCKY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7691 5 MILE RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45230-4348
Mailing Address - Country:US
Mailing Address - Phone:513-232-3332
Mailing Address - Fax:513-232-9635
Practice Address - Street 1:7691 5 MILE RD
Practice Address - Street 2:STE. 312
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45230-4348
Practice Address - Country:US
Practice Address - Phone:513-232-3332
Practice Address - Fax:513-232-9635
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-04-9417208000000X
OH35.049417207NP0225X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207NP0225XAllopathic & Osteopathic PhysiciansDermatologyPediatric Dermatology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics