Provider Demographics
NPI:1366446072
Name:LUCIANO, CARMEN S (DPM)
Entity Type:Individual
Prefix:DR
First Name:CARMEN
Middle Name:S
Last Name:LUCIANO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:324 ELM ST
Mailing Address - Street 2:STE 101A
Mailing Address - City:MONROE
Mailing Address - State:CT
Mailing Address - Zip Code:06468-2281
Mailing Address - Country:US
Mailing Address - Phone:203-261-9700
Mailing Address - Fax:203-459-8974
Practice Address - Street 1:324 ELM ST
Practice Address - Street 2:STE 101A
Practice Address - City:MONROE
Practice Address - State:CT
Practice Address - Zip Code:06468-2281
Practice Address - Country:US
Practice Address - Phone:203-261-9700
Practice Address - Fax:203-459-8974
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-09
Last Update Date:2011-02-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT000115213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT061556408-0002OtherCIGNA
CTZS536OtherOXFORD
CT030000115CT02OtherANTHEM BLUE CROSS/BLUE SH
CT1529188OtherUNITED HEALTHCARE
CT1952555062OtherDMERC
CT004006219Medicaid
CTOV5650OtherHEALTH NET
CT2178064OtherAETNA
CT2178064OtherAETNA
CTT22090Medicare UPIN