Provider Demographics
NPI:1407942345
Name:DELUCA, JOHN A (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:A
Last Name:DELUCA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1220 LEE ST E STE 208
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25301-1864
Mailing Address - Country:US
Mailing Address - Phone:304-388-7270
Mailing Address - Fax:304-388-7280
Practice Address - Street 1:1220 LEE ST E STE 208
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25301-1864
Practice Address - Country:US
Practice Address - Phone:304-388-7270
Practice Address - Fax:304-388-7280
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2022-09-14
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Provider Licenses
StateLicense IDTaxonomies
WV17201208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0126087000Medicaid
WVDE0765302Medicare ID - Type Unspecified
WV0126087000Medicaid