Provider Demographics
NPI:1609883735
Name:KAPELUSZNIK, LUCIANO (MD)
Entity Type:Individual
Prefix:
First Name:LUCIANO
Middle Name:
Last Name:KAPELUSZNIK
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 1:825 OLD LANCASTER RD
Mailing Address - Street 2:SUITE 320
Mailing Address - City:BRYN MAWR
Mailing Address - State:PA
Mailing Address - Zip Code:19010-3231
Mailing Address - Country:US
Mailing Address - Phone:610-527-3800
Mailing Address - Fax:610-527-0334
Practice Address - Street 1:825 OLD LANCASTER RD
Practice Address - Street 2:SUITE 320
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010-3231
Practice Address - Country:US
Practice Address - Phone:610-527-3800
Practice Address - Fax:610-527-0334
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2017-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD-448567207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDS062-0436OtherCAREFIRST BC/BS - REGIONAL
MD550704900Medicaid
MD974684-01OtherCAREFIRST BC/BS
MD974684-01OtherCAREFIRST BC/BS
MDP01041966Medicare PIN
MD222644Y2ZMedicare PIN