Provider Demographics
NPI:1497761399
Name:LUCKIEWICZ, HALINA ELIZABETH (MD)
Entity Type:Individual
Prefix:
First Name:HALINA
Middle Name:ELIZABETH
Last Name:LUCKIEWICZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9104 BABCOCK BLVD
Mailing Address - Street 2:SUITE 1113
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15237
Mailing Address - Country:US
Mailing Address - Phone:412-366-7070
Mailing Address - Fax:412-369-8355
Practice Address - Street 1:9104 BABCOCK BLVD
Practice Address - Street 2:SUITE 1113
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15237
Practice Address - Country:US
Practice Address - Phone:412-366-7070
Practice Address - Fax:412-369-8355
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2007-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD066037L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018622710050005Medicaid
PA01684KDJMedicare PIN
G78838Medicare UPIN