Provider Demographics
NPI:1467470641
Name:LUCKE, CATERINA GIUSEPPA (PA)
Entity Type:Individual
Prefix:MRS
First Name:CATERINA
Middle Name:GIUSEPPA
Last Name:LUCKE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MISS
Other - First Name:CATERINA
Other - Middle Name:GIUSEPPA
Other - Last Name:MERLINO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:600 MCCLELLAN ST
Mailing Address - Street 2:2 WEST
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12304-1009
Mailing Address - Country:US
Mailing Address - Phone:518-347-5400
Mailing Address - Fax:
Practice Address - Street 1:1101 NOTT ST
Practice Address - Street 2:
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12308-2425
Practice Address - Country:US
Practice Address - Phone:518-243-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2010-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004607363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY040608000009OtherFIDELIS
NY000407476001OtherBLUE SHIELD
NYQ04111Medicare UPIN
NYPA0081Medicare ID - Type Unspecified