Provider Demographics
NPI:1417026832
Name:LUCA, DRAGOS C (MD)
Entity Type:Individual
Prefix:
First Name:DRAGOS
Middle Name:C
Last Name:LUCA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:117 ELLENFIELD ST STE 101
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02905-4541
Mailing Address - Country:US
Mailing Address - Phone:401-444-6779
Mailing Address - Fax:401-444-6912
Practice Address - Street 1:2525 CHICAGO AVE SOUTH
Practice Address - Street 2:CHILDRENS HOSPITALS AND CLINICS PATHOLOGY MPLS
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404
Practice Address - Country:US
Practice Address - Phone:612-813-6280
Practice Address - Fax:612-813-6951
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2024-03-29
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Provider Licenses
StateLicense IDTaxonomies
MN49092207ZH0000X, 207ZP0102X, 207ZP0213X
RIMD18279207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZH0000XAllopathic & Osteopathic PhysiciansPathologyHematology
No207ZP0213XAllopathic & Osteopathic PhysiciansPathologyPediatric Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34899100Medicaid