Provider Demographics
NPI:1558350405
Name:LUCIANO, ANTHONY A (MD)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:A
Last Name:LUCIANO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:263 FARMINGTON AVE
Mailing Address - Street 2:PROVIDER ENROLLMENT
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06030-2212
Mailing Address - Country:US
Mailing Address - Phone:860-276-6020
Mailing Address - Fax:860-276-6059
Practice Address - Street 1:1115 WEST ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:SOUTHINGTON
Practice Address - State:CT
Practice Address - Zip Code:06489-6025
Practice Address - Country:US
Practice Address - Phone:860-276-6043
Practice Address - Fax:860-276-6059
Is Sole Proprietor?:No
Enumeration Date:2005-10-13
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT17123207VE0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive Endocrinology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT010017123CT 05OtherANTHEM BLUE CROSE & BLUE
CT2V5829OtherHEALTH NET
3786055OtherAETNA USHEALTH CARE
CT010017123CT 04OtherANTHEM BLUE CROSE & BLUE
CT0011711230Medicaid
CT20-1997579OtherPRIVATE HEALTH CARE SYSTE
CTHAS392OtherOXFORD HEALTH
CT0152719OtherCIGNA -1-800-244-6224
CT001171230-03NBOtherANTHEM BLUE CARE FAMILY P
CT001171230-04HTFDOtherANTHEM BLUE CARE FAMILY P
CT20-1997579OtherUNITED HEALTH CARE
CT0011711230Medicaid
CT20-1997579OtherPRIVATE HEALTH CARE SYSTE