Provider Demographics
NPI:1558330217
Name:MUCA, ERIC I (DPM)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:I
Last Name:MUCA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:SACO
Mailing Address - State:ME
Mailing Address - Zip Code:04072-3113
Mailing Address - Country:US
Mailing Address - Phone:207-282-6330
Mailing Address - Fax:207-283-3338
Practice Address - Street 1:333 LINCOLN ST
Practice Address - Street 2:
Practice Address - City:SACO
Practice Address - State:ME
Practice Address - Zip Code:04072-3113
Practice Address - Country:US
Practice Address - Phone:207-282-6330
Practice Address - Fax:207-283-3338
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-15
Last Update Date:2018-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPOD1025213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
038319OtherANTHEM
2292732OtherAETNA
ME6793980001OtherMEDICARE PTAN
6793980001OtherNCS DME
ME038319OtherANTHEM
ME221470099Medicaid
038319OtherANTHEM
ME221470099Medicaid
2292732OtherAETNA