Provider Demographics
NPI:1306846225
Name:LUSCAVAGE, LONNIE (MD)
Entity Type:Individual
Prefix:DR
First Name:LONNIE
Middle Name:
Last Name:LUSCAVAGE
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 1:1008 WAWASET RD
Mailing Address - Street 2:
Mailing Address - City:KENNETT SQUARE
Mailing Address - State:PA
Mailing Address - Zip Code:19348-1002
Mailing Address - Country:US
Mailing Address - Phone:610-347-1200
Mailing Address - Fax:610-347-1201
Practice Address - Street 1:1008 WAWASET RD
Practice Address - Street 2:
Practice Address - City:KENNETT SQUARE
Practice Address - State:PA
Practice Address - Zip Code:19348-1002
Practice Address - Country:US
Practice Address - Phone:610-347-1200
Practice Address - Fax:610-347-1201
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-22
Last Update Date:2013-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA066768L207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA050257EGVMedicare ID - Type Unspecified
PAH33917Medicare UPIN