Provider Demographics
NPI:1558366864
Name:D'AMATO, LUCIANO (MD)
Entity Type:Individual
Prefix:DR
First Name:LUCIANO
Middle Name:
Last Name:D'AMATO
Suffix:
Gender:M
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:PO BOX 3416
Mailing Address - Street 2:
Mailing Address - City:WISE
Mailing Address - State:VA
Mailing Address - Zip Code:24293-3416
Mailing Address - Country:US
Mailing Address - Phone:276-328-7050
Mailing Address - Fax:276-328-2989
Practice Address - Street 1:411 W MAIN ST
Practice Address - Street 2:
Practice Address - City:WISE
Practice Address - State:VA
Practice Address - Zip Code:24293-6904
Practice Address - Country:US
Practice Address - Phone:276-328-7050
Practice Address - Fax:273-328-2989
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101039667174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAB08228Medicare UPIN