Provider Demographics
NPI:1336132786
Name:LUCHINI, MARIANNE M (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIANNE
Middle Name:M
Last Name:LUCHINI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:2011 DESERT SPRINGS CT
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-4989
Mailing Address - Country:US
Mailing Address - Phone:505-603-3462
Mailing Address - Fax:505-629-1526
Practice Address - Street 1:104 LEGION DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NM
Practice Address - Zip Code:87701-4804
Practice Address - Country:US
Practice Address - Phone:505-603-3462
Practice Address - Fax:505-629-1526
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-31
Last Update Date:2011-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM20020335207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM74225014Medicaid
NMH76323Medicare UPIN