Provider Demographics
NPI:1326361163
Name:LUCCIOLA, MARION (MD)
Entity Type:Individual
Prefix:DR
First Name:MARION
Middle Name:
Last Name:LUCCIOLA
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 1:129 WALTON AVE
Mailing Address - Street 2:
Mailing Address - City:NEW PROVIDENCE
Mailing Address - State:NJ
Mailing Address - Zip Code:07974-1748
Mailing Address - Country:US
Mailing Address - Phone:908-790-0216
Mailing Address - Fax:
Practice Address - Street 1:11 OVERLOOK RD
Practice Address - Street 2:STE 170
Practice Address - City:SUMMIT
Practice Address - State:NJ
Practice Address - Zip Code:07901-3577
Practice Address - Country:US
Practice Address - Phone:908-277-4480
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-08
Last Update Date:2010-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07901700208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics