Provider Demographics
NPI:1407848302
Name:PLUCIS, ASTRIDA A (MD)
Entity Type:Individual
Prefix:
First Name:ASTRIDA
Middle Name:A
Last Name:PLUCIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ASTRIDA
Other - Middle Name:ANTONIA
Other - Last Name:PLUCIS-TURKOPULIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:92 W WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-2432
Mailing Address - Country:US
Mailing Address - Phone:410-263-2540
Mailing Address - Fax:
Practice Address - Street 1:92 W WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-2432
Practice Address - Country:US
Practice Address - Phone:410-263-2540
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0023455207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD7605-0040OtherCAREFIRST BLUECHOICE
MD831586OtherMAMSI PRIMARY CARE
MD4313159OtherAETNA FEE FOR SERVICE
MDP11947OtherCAREFIRST MPOS
MDD0023455OtherMHIP PROVIDER ID
MD024100OtherJHHC PROVIDER NUMBER
MD231586OtherMAMSI SPECIALIST
MD01-00597OtherUHC PROVIDER NUMBER
MD1404109OtherCIGNA PIN
MD0475278OtherAETNA CAPITATED
MD419305-01OtherCAREFIRST MD RENDERING
MDD0023455OtherMHIP PROVIDER ID
MD1404109OtherCIGNA PIN